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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422829
Report Date: 03/10/2023
Date Signed: 03/10/2023 10:37:30 AM


Document Has Been Signed on 03/10/2023 10:37 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:RANDALL, PAMELAFACILITY NUMBER:
013422829
ADMINISTRATOR:RANDALL, PAMELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 213-5166
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:14CENSUS: 3DATE:
03/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Pamela RandallTIME COMPLETED:
10:45 AM
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On March 10, 2023 at 10:15 AM Licensing Program Analyst (LPA) Elimika Woods conducted a case management visit to check on the status of a child. Present in the home was the licensee Pamela Randall her fingerprint cleared daughter, A. Randall, and 3 preschool children. The licensee stated that CPS interviewed C1 at his home along with some other children after the alleged incident. The child has not been back to daycare and is no longer enrolled at this facility.

There were no deficiencies cited during the visit. A notice of site visit was posted near the entrance to the facility, and must remain posted for 30 days.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2023
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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