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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422117
Report Date: 04/20/2022
Date Signed: 04/20/2022 10:07:32 AM


Document Has Been Signed on 04/20/2022 10:07 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 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: 11DATE:
04/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Alicia ReedTIME COMPLETED:
10:20 AM
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On 4/20/2022, Licensing Program Analyst (LPA) Jonathan Williams arrived at the facility unannounced for the purposes of conducting a Case Management inspection to verify correction of deficiencies cited on 3/3/2022. LPA was met by Licensee, one fingerprint cleared and associated staff member, and 11 preschool-aged children in care.

On 3/3/2022, LPA discovered during review of facility personnel records that immunization records for an assistant provider were not present in the facility. Type B deficiency was cited. During today's visit, Licensee stated that assistant provider present during visit conducted on 3/3/2022 has returned to her home country and Licensee stated that she will not return to the facility until she is in compliance with the immunization requirement for child care providers set forth in the Health and Safety Code (HSC), subsection 1597.622(c). Deficiency cleared during today's visit.

LPA conducted record review of personnel records during today's visit and found that the assistant provider present during today's visit is in compliance with immunization requirement set forth in HSC 1597.622(c).

Three additional Type B deficiencies cleared today based on email submitted to LPA by Licensee.

Licensee is reminded that any changes to the Licensee's phone number must be reported to the Department in a timely fashion.

Exit interview conducted. Appeal Rights provided.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022
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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