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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408994
Report Date: 05/13/2022
Date Signed: 05/13/2022 11:36:29 AM


Document Has Been Signed on 05/13/2022 11:36 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:FORD, TAMIKAFACILITY NUMBER:
073408994
ADMINISTRATOR:FORD, TAMIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 680-9207
CITY:RICHMONDSTATE: CAZIP CODE:
94801
CAPACITY:14CENSUS: 4DATE:
05/13/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:12 AM
MET WITH:Tamika FordTIME COMPLETED:
11:50 AM
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1On Friday, May 13, 2022, Licensing Program Analyst (LPA) Caroline Colson met with Tamika Ford for an unannounced plan of correction inspection at 10:12 AM Joyce Bratton-Scott, a family relative, arrived during the inspection. There are three (3) infants and one (1) preschool child present. Her teenage son is present. The purpose of this inspection is to ensure all corrections have been made from the Random Annual conducted on April 8, 2022. All corrections have been 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: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2022
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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