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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423850
Report Date: 09/27/2024
Date Signed: 09/27/2024 04:18:22 PM

Document Has Been Signed on 09/27/2024 04:18 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:COOPER, DAEJENAEFACILITY NUMBER:
013423850
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 16CENSUS: 0DATE:
09/27/2024
TYPE OF VISIT:Annual/RandomANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Daejenae CooperTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
NARRATIVE
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On 9/27/2024 at 2:50pm, Licensing Program Analyst (LPA) Catherine Fernandes met with Licensee Daejenae Cooper for an announced Random Inspection in conjunction with an increase in capacity.

There were no children in care during the inspection. Present during the inspection was the licensee and her underage child.

Due to time constraints the increase and annual inspection will have to be continued at a later date.


Exit interview conducted
Report, Appeal Rights and Notice of site visit provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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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