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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213704
Report Date: 11/08/2022
Date Signed: 11/08/2022 02:35:44 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/08/2022 02:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:PIEDMONT SCHOOLMATES - HAVENSFACILITY NUMBER:
010213704
ADMINISTRATOR:MURPHY, MICHAELFACILITY TYPE:
850
ADDRESS:323 HIGHLANDTELEPHONE:
(510) 420-3078
CITY:PIEDMONTSTATE: CAZIP CODE:
94611
CAPACITY:50CENSUS: 0DATE:
11/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Katrina TIME COMPLETED:
02:35 PM
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On 11/8/22 at 1:50PM Licensing Program Analyst (LPA) Michelle Sutton attempted to conduct an unannounced 5-Year Annual Inspection at Piedmont Schoolmates-Havens. LPA met with the Recreation Supervisor Katrina Morris, who oversees City of Piedmont after school programs for Beach Schoolmates, Haven Schoolmates and Wildwood Schoolmates. Katrina Morris stated that their program is ran as a Recreation Program, operating 20 hours a week as of August of 2020. Katrina requested to close all 3 facilities. LPA did not conduct a 5-Year annual inspection due to program now running as exempt.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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