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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214203
Report Date: 07/17/2023
Date Signed: 07/17/2023 11:06:50 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/17/2023 11:06 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:LARSON, ARTHENAFACILITY NUMBER:
010214203
ADMINISTRATOR:LARSON, ARTHENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 635-3040
CITY:OAKLANDSTATE: CAZIP CODE:
94603
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 3DATE:
07/17/2023
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Arthena LarsonTIME COMPLETED:
11:20 AM
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On 7/17/23, Licensing Program Manager (LPM) Loretta Dyson and Licensing Program Analyst (LPA) Randall Dunevant arrived at the home for an unannounced random inspection. LPM and LPA met with the licensee. There were 3 children in care.

LPM discovered that a random inspection had been completed by LPA Campos on 6/26/23. No further inspection was completed today.

There are no deficiencies being cited today. An exit interview was conducted with the licensee.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2023
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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