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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423944
Report Date: 03/18/2024
Date Signed: 03/18/2024 03:03:16 PM

Document Has Been Signed on 03/18/2024 03:03 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:KAHN, VANESSAFACILITY NUMBER:
013423944
ADMINISTRATOR:VANESSA KAHNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 455-9553
CITY:OAKLANDSTATE: CAZIP CODE:
94608
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/18/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Vanessa KahnTIME COMPLETED:
03:15 PM
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Licensing Program Analysts (LPAs) Ashley Akinleye, Monica Mathur and Licensing Program Manager (LPM) Sherelle Johnson met with applicant Vanessa Kahn for an Informal Meeting at Oakland Regional Office.The purpose of the meeting was to discuss unlicensed care being provided and the applicant’s pending application for a Large Family Child Care Home.

Applicant states she has stopped providing unlicensed care as of 3/16/24 and has attempted to set an appointment with the Fire Department for the Fire Inspection required for a Large Family Child Home Application. During the meeting options were discussed on how to get her license expedited. She advised that she will decrease pending application to a small license. Consultation was provided for the application process for a small license. A plan was discussed about additional items that are needed to complete the process.

According to the information provided today, the applicant has ceased operation and proof was provided. Applicant will continue to work with licensing to obtain a license for a Family Child Care Home.LPA will provided applicant with a revised Notice of Incomplete Application pending new application for a Small Family Child Care Home via email by end of the day.

Required Information to be submitted no later than 4/18/24.

1. Verification of separate legal addresses from landlord

2. Big Room/Converted Garage Permit

Report continues on 809-C

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Ashley Akinleye
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: KAHN, VANESSA
FACILITY NUMBER: 013423944
VISIT DATE: 03/18/2024
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3. Immunization: TDAP, MMR, and Influenza or Opt-out Statement (Applicant)
4. Immunizations, TB for all Adults and Assistants in the home
5. Mandated Reporter Training for all assistants working with children
6. Fingerprint clearance for all Adults and Assistants in the home
7. Updated Application for Small Family Child Care LIC279
8. Emergency Disaster Plan LIC610A
9. Current Children in Home LIC279B
10. Roster LIC9040

Exit interview conducted with Vanessa Kahn. Appeal Rights were provided,
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Ashley Akinleye
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
LIC809 (FAS) - (06/04)
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