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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420469
Report Date: 05/16/2023
Date Signed: 05/16/2023 10:08:39 AM


Document Has Been Signed on 05/16/2023 10:08 AM - 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:THOMPSON, SANDARAFACILITY NUMBER:
013420469
ADMINISTRATOR:THOMPSON, SANDARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 635-3139
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:14CENSUS: 5DATE:
05/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sandara ThompsonTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Lisa Dyer met with Licensee Sandara Thompson for a Case Management Inspection to discuss records, training, and sleep logs. Present today at the facility: the licensee, 1 fingerprint cleared staff member, 3 infants and 2 preschoolers.

No deficiencies were cited during today's inspection. Notice of site visit must remain posted for 30 days. Exit interview conducted with Licensee Sandara Thompson.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 725-7006
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
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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