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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408994
Report Date: 04/15/2022
Date Signed: 04/19/2022 04:08:48 PM


Document Has Been Signed on 04/19/2022 04:08 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:FORD, TAMIKAFACILITY NUMBER:
073408994
ADMINISTRATOR:FORD, TAMIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 680-9207
CITY:RICHMONDSTATE: CAZIP CODE:
94801
CAPACITY:14CENSUS: 5DATE:
04/15/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Tamika FordTIME COMPLETED:
03:25 PM
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On April 15, 2022, Licensing Program Analyst (LPA) Caroline Colson met with Tamika Ford for an unannounced plan of correction inspection at 1:48 PM. There are three (3) infants, two (2) preschool children and three (3) school age children present. The purpose of the inspection is to clear a deficiency due from the April 8, 2022 Random Annual Inspection. Deficiency was cleared. Records were reviewed.

There were no deficiencies cited during this inspection. Appeal Rights were given. Exit interview was conducted. This report must be made available for 3 years.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:
DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/15/2022
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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