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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416167
Report Date: 07/13/2023
Date Signed: 07/13/2023 01:39:33 PM


Document Has Been Signed on 07/13/2023 01:39 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:COLEMAN, BEVERLYFACILITY NUMBER:
013416167
ADMINISTRATOR:COLEMAN, BEVERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 978-0744
CITY:OAKLANDSTATE: CAZIP CODE:
94603
CAPACITY:14CENSUS: 5DATE:
07/13/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Beverly ColemanTIME COMPLETED:
01:42 PM
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On 7/13/23 at 1:15pm, Licensing Program Manager (LPM) Loretta Dyson arrived at the home to conduct an unannounced plan of correction inspection. LPM met with Beverly Coleman. There were 5 preschool aged children, and the licensee's teenage grandson and granddaughter were also present.

LPM did an inspection of the child care area, to ensure that the items noted in the deficiency cited on 7/12/23 have been completed. LPM observed that the gate leading to the upper level of the home is closed and secure. LPM observed that the gate blocking the wall heater is secure and able to prevent access by children. LPM did not observe any cleaning supplies or hazardous items accessible to children today. The licensee provided a plan on how she will get the fire extinguisher replaced.

LPM cleared the deficiencies and provided the licensee with the Letter of Deficiency Citations Cleared. There are no deficiencies being cited today. An exit interview was conducted with the licensee, Beverly Coleman.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023
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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