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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423128
Report Date: 06/18/2024
Date Signed: 06/18/2024 04:42:42 PM

Document Has Been Signed on 06/18/2024 04:42 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:SMALLTRANS BEARSFACILITY NUMBER:
013423128
ADMINISTRATOR/
DIRECTOR:		JACKSON-BURNS, CYNTHIAFACILITY TYPE:
830
ADDRESS:111 GRAND AVENUETELEPHONE:
(510) 286-5130
CITY:OAKLANDSTATE: CAZIP CODE:
94612
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 10DATE:
06/18/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:09 PM
MET WITH:Cynthia Jackson-BurnsTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On June 18, 2024 at 9:20am Licensing Program Analysts (LPAs) Indira Loza and Catherine Fernandes met with Director Cynthia Jackson-Burns to conduct an Annual/Random inspection. Present during today's inspection were 5 infants, 5 toddlers, and 4 fingerprint cleared staff. LPAs toured the facility for a Health and Safety check.

Due to time constraints, this annual inspection will be continued at a later date.

Exit Interview conducted with Cynthia Jackson-Burns.
Report and Appeal Rights provided.
Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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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