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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415366
Report Date: 09/21/2022
Date Signed: 09/21/2022 03:06:52 PM


Document Has Been Signed on 09/21/2022 03:06 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 STE 1102
OAKLAND, CA 94612



FACILITY NAME:KIDANGO-HILLVIEW CREST CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013415366
ADMINISTRATOR:SHAHID, FARAHFACILITY TYPE:
850
ADDRESS:31410 WHEELON AVENUETELEPHONE:
(510) 907-1543
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:24CENSUS: 11DATE:
09/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Kavitha RameshTIME COMPLETED:
03:25 PM
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On September 21, 2022 at 2:00 PM, License Program Analyst Elimika Woods made a case management visit to serve an "Order of Immediate Exclusion of Individual from Facility," Kidango-Hillcrest Child Care Center license and an exclusion action for Tiffany Mims. LPA Woods could not served Tiffany Mims because the director stated she does not work at this site. A copy of the Order to Individual of Immediate Exclusion and appeal rights were explained to the director and provided.

Upon arrival there where eleven (11) children in care, and two fingerprinted cleared associates, A. Bala and M. Avalos. Tiffany Mims was not present during the case management visit
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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