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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402613
Report Date: 09/21/2022
Date Signed: 09/21/2022 01:02:26 PM


Document Has Been Signed on 09/21/2022 01:02 PM - 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:CONTRA COSTA CO. HEAD START - BALBOA CDCFACILITY NUMBER:
073402613
ADMINISTRATOR:DOSS, MARILYNFACILITY TYPE:
830
ADDRESS:1001 - SOUTH 57TH STTELEPHONE:
(510) 374-7025
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY:38CENSUS: 18DATE:
09/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Tana ReedTIME COMPLETED:
01:00 PM
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On Wednesday, September 21, 2022 at 10:15 AM, Licensing Program Analyst (LPA) Caroline Colson met with Tana Reed, Site Supervisor I, for an unannounced case management inspection regarding Lead Testing Results. There are 18 children and 11 staff members. A tour of the facility was conducted. Pictures were taken. Documentation was obtained. It was concluded that all faucets on the Infant/Toddler license have no high amounts of lead in the water based upon the Lead Testing Results.

There were no deficiencies cited during this inspection.

A notice of site visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with Tana Reed, Site Supervisor l.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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