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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423100
Report Date: 08/15/2023
Date Signed: 08/16/2023 09:07:19 AM

Document Has Been Signed on 08/16/2023 09:07 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:SWINGS AND WINGS-LITTLE BUTTERFLIESFACILITY NUMBER:
013423100
ADMINISTRATOR:KAZI-KOYA, SADIYAFACILITY TYPE:
850
ADDRESS:2307 BLANDING AVENUE, SUITE ETELEPHONE:
(510) 747-9740
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: DATE:
08/15/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Sadiya Kazi-KoyaTIME COMPLETED:
03:15 PM
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On Tuesday, August 15, 2023 at 3:00 pm, Regional Manager Diane Perez, Assistant Program Administrator (APA) Carol Marcroft, and Licensing Program Manager (LPM) Mayla Mendoza, met with Owner Sadiya Kazi-Koya for a virtual office meeting.

The meeting was held to discuss the licensee’s request to change the operating hours from 8:30am-1:00pm to 7:30am-5:30pm, Monday through Friday. Licensee is to provide an updated LIC 200A with the original signature to the Oakland Regional Office. The regulation section 101220, Child's Medical Assessments was reviewed with the licensee. She understands that prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child.

The conditions of the outdoor waiver were reviewed with the licensee. Ms. Kazi-Koya understands that the Swing Room and Jump Room are dedicated for gross motor activities in lieu of outdoor play space. Licensee was advised the waiver needs to be posted with the license at the facility.

LPM Mendoza reviewed and provided a copy of the report to the Licensee.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Mayla Mendoza
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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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