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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414296
Report Date: 01/25/2023
Date Signed: 01/25/2023 04:30:22 PM


Document Has Been Signed on 01/25/2023 04:30 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:LEWIS, PAMELAFACILITY NUMBER:
013414296
ADMINISTRATOR:LEWIS, PAMELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 635-2303
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:14CENSUS: 6DATE:
01/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Pamela LewisTIME COMPLETED:
04:40 PM
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Licensing Program Analyst Lisa Dyer met with licensee Pamela Lewis for an unannounced Case Management Inspection. Present at the inspection was the licensee; one assistant; 4 school age children, and 2 preschool children. Reason for the Case management visit was to inspect the entire home. Licensee provided a tour of the entire home on Morse Avenue. The off limit upstairs area consists of 3 bedrooms, 1 bathroom, living room, dining room, kitchen and office.
There were no deficiencies cited.
A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023
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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