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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073408581
Report Date:
03/24/2022
Date Signed:
03/24/2022 01:05:22 PM
Document Has Been Signed on
03/24/2022 01:05 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:
GARROWAY, RECCA
FACILITY NUMBER:
073408581
ADMINISTRATOR:
GARROWAY, RECCA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(718) 301-3848
CITY:
ANTIOCH
STATE:
CA
ZIP CODE:
94531
CAPACITY:
14
CENSUS:
5
DATE:
03/24/2022
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
09:03 AM
MET WITH:
RECCA GARROWAY
TIME COMPLETED:
01:00 PM
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9:00AM- LICENSING PROGRAM ANALYST ALEXANDER MET WITH LICENSEE RECCA GARROWAY TO DISCUSS AN UNUSUAL INCIDENT THAT WAS REPORTED TO COMMUNITY CARE LICENSING ON 3/14/22 BY LICENSEE.
TODAY THERE ARE NO DEFICIENCIES CITED.
AN EXIT INTERVIEW WAS CONDUCTED.
SUPERVISOR'S NAME:
Loretta Dyson
TELEPHONE:
(510) 695-0243
LICENSING EVALUATOR NAME:
Tasha Hackett-Alexander
TELEPHONE:
(510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE:
03/24/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/24/2022
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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