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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423850
Report Date: 12/11/2024
Date Signed: 12/11/2024 03:12:15 PM

Document Has Been Signed on 12/11/2024 03:12 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
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: 0CENSUS: 0DATE:
12/11/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:54 PM
MET WITH:Jet IsakTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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On 12/11/2024 at 2:54pm, Licensing Program Analyst (LPA) Catherine Fernandes met with Jet Isak for an announced case management regarding the home's capacity increase. At the time of the visit the Licensee Daejenae Cooper was not home and no children were in care. Present during the visit was Licensee's two underage children and Isak.

While at the home LPA Fernandes tested the smoke detector and carbon monoxide both were in working condition.

As of 12/11/24 the home is approved for an increase in capacity.

LPA got permission to review the report with Isak and for her to sign for todays report.


Exit interview conducted with Isak
Report, Appeal Rights and Notice of site visit provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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