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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422117
Report Date: 06/12/2019
Date Signed: 06/12/2019 11:07:52 AM

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:REED, ALICIAFACILITY NUMBER:
013422117
ADMINISTRATOR:REED, ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 359-2460
CITY:NEWARKSTATE: CAZIP CODE:
94560
CAPACITY:14CENSUS: 0DATE:
06/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Alicia ReedTIME COMPLETED:
11:25 AM
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On 06/04/19, Licensing Program Analyst Briana Plumboy met with licensee Alicia Reed for an UNANNOUNCED POC INSPECTION. Present for this visit was assistants Cassidy Melendez and Sandleen Belgaumi Masooda Jafari. The home was toured.

The licensee is in ratio today. LPA received the POC summary for ratio on Monday 06/10/19.

There are no deficiencies cited today. The ratio/capacity citation is cleared today. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
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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