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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
013423039
Report Date:
03/09/2022
Date Signed:
03/09/2022 10:59:56 AM
Document Has Been Signed on
03/09/2022 10:59 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:
YMCA EASTLAKE CENTER
FACILITY NUMBER:
013423039
ADMINISTRATOR:
MARTA PEREIRA
FACILITY TYPE:
830
ADDRESS:
1612-45TH AVE
TELEPHONE:
(510) 370-2966
CITY:
OAKLAND
STATE:
CA
ZIP CODE:
94601
CAPACITY:
34
CENSUS:
9
DATE:
03/09/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:07 AM
MET WITH:
Lovette Trammel
TIME COMPLETED:
11:15 AM
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Licensing Program Analysts (LPA's) Cherie Acosta and Diana Campos arrived at the facility and met with center Director Lovette Trammel for the purpose of conducting a Case Management inspection to amend a report created in error. On 12/10/2021 a report was created in error and a deficiency cited on the Infant component 013423039. No visit was was conducted at this facility number on that date.
No deficiencies cited today.
Notice of Site Visit was provided and must remain posted for 30 days. Exit interview conducted with center Director Lovette Trammel.
SUPERVISOR'S NAME:
Sherelle Johnson
TELEPHONE:
(510) 622-2592
LICENSING EVALUATOR NAME:
Diana Campos
TELEPHONE:
(510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE:
03/09/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/09/2022
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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