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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403933
Report Date: 12/07/2023
Date Signed: 12/07/2023 01:04:54 PM


Document Has Been Signed on 12/07/2023 01:04 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:COLE, PAULINEFACILITY NUMBER:
073403933
ADMINISTRATOR:COLE, PAULINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 223-2229
CITY:RICHMONDSTATE: CAZIP CODE:
94806
CAPACITY:14CENSUS: 5DATE:
12/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Pauline ColeTIME COMPLETED:
01:15 PM
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On December 7, 2023 at 12:30pm Licensing Program Analyst (LPA) Indira Loza met with Licensee Pauline Cole. Present during today's visit were 4 preschoolers and one infant. LPA toured the facility for a health and safety check.

The purpose of the visit was due to a self reported incident that was sent to the Oakland Regional office. The Investigations Bureau obtained police records related to the incident.

No deficiencies were cited during today's visit.

Exit interview conducted.
A copy of the report and appeal rights provided to Licensee Pauline Cole.
Notice of Site Visit provided.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2023
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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