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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422719
Report Date: 09/10/2019
Date Signed: 09/10/2019 06:06:49 PM

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:SPEARS, SABRINAFACILITY NUMBER:
013422719
ADMINISTRATOR:SPEARS, SABRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 688-5186
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:14CENSUS: 8DATE:
09/10/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:15 PM
MET WITH:Sabrina SpearsTIME COMPLETED:
06:15 PM
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LPA Dyer met with licensee Sabrina Spears for an Unannounced Case Management inspection to review Acknowledgement of Receipt of Licensing Reports.

Ten forms were reviewed. There were sixteen children's names listed on the ten forms.

No deficiencies cited. Exit interview conducted. Notice of site visit was posted at the time of the inspection, and must remain posted for 30 days. This report must be kept available for public review for 3 years.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019
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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