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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
013423100
Report Date:
01/27/2025
Date Signed:
01/27/2025 05:12:12 PM
Document Has Been Signed on
01/27/2025 05:12 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
OAKLAND CC RO
,
1515 CLAY STREET, SUITE 1102
OAKLAND
,
CA
94612
FACILITY NAME:
SWINGS AND WINGS-LITTLE BUTTERFLIES
FACILITY NUMBER:
013423100
ADMINISTRATOR/
DIRECTOR:
KAZI-KOYA, SADIYA
FACILITY TYPE:
850
ADDRESS:
2307 BLANDING AVENUE, SUITE E
TELEPHONE:
(510) 747-9740
CITY:
ALAMEDA
STATE:
CA
ZIP CODE:
94501
CAPACITY:
15
TOTAL ENROLLED CHILDREN:
15
CENSUS:
5
DATE:
01/27/2025
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
04:49 PM
MET WITH:
Samantha Hernandez
TIME VISIT/
INSPECTION COMPLETED:
05:20 PM
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LPAs K. Merchant and D. Campos conducted a case management inspection as a result of a self reported incident received on 1/10/2025. Present during this inspection was 1 staff and 5 preschool children in care. Reporting requirements were discussed with acting Director Samantha Hernandez.
No deficiencies were cited as a result of this visit.
Exit interview conducted with acting Director Samantha Hernandez.
SUPERVISORS NAME
:
Sherelle Johnson
LICENSING EVALUATOR NAME
:
Diana Campos
LICENSING EVALUATOR SIGNATURE
:
DATE:
01/27/2025
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/27/2025
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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