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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408203
Report Date: 07/05/2023
Date Signed: 07/05/2023 10:21:41 AM


Document Has Been Signed on 07/05/2023 10:21 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:KIDS CORNER LEARNING CENTERFACILITY NUMBER:
073408203
ADMINISTRATOR:TABIQUE, MELISSAFACILITY TYPE:
850
ADDRESS:716 APPIAN WAYTELEPHONE:
(510) 758-5532
CITY:EL SOBRANTESTATE: CAZIP CODE:
94803
CAPACITY:70CENSUS: 24DATE:
07/05/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:TABIQUE, MELISSATIME COMPLETED:
10:30 AM
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THIS REPORT IS AN AMENDED REPORT FROM ORIGINAL REPORT DATED JUNE 14, 2023.

On July 5, 2023, at 8:30 AM Licensing Program Analyst (LPA) Nyeesha Blount conducted an unannounced case management inspection for an unusual incident report that was reported on June 2, 2023. During today's inspection was (7) staff members, (24) preschool children present. LPA met with Director Melissa Tabique she advised the teacher had only worked at the facility for 2 (1/2) weeks and is no longer at the facility.Director stated she was off work when the issued occurred and was advised by (2) staff members.

There were no deficiencies during today’s visit, exit interview and report reviewed with Director Tabique, Melissa.

Notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2023
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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