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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073401411
Report Date:
03/02/2022
Date Signed:
03/02/2022 02:33:49 PM
Document Has Been Signed on
03/02/2022 02:33 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:
CONTRA COSTA COUNTY HEAD START - MARSH CREEK
FACILITY NUMBER:
073401411
ADMINISTRATOR:
AFI FIAXE
FACILITY TYPE:
850
ADDRESS:
7251 BRENTWOOD BLVD
TELEPHONE:
(925) 427-8576
CITY:
BRENTWOOD
STATE:
CA
ZIP CODE:
94513
CAPACITY:
36
CENSUS:
15
DATE:
03/02/2022
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
09:45 AM
MET WITH:
Afi Fiaxe
TIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management inspection to follow up on a self reported incident. LPA met with Director Afi Fiaxe. LPA and director also discussed and reviewed the director's packet submitted to Community Care Licensing (CCL).
During the inspection LPA conducted interviews reviewed and obtained copies of documents.
Director agrees to submit proof of her 8 hour EMSA approved preventative health practice and proof of current CPR/First Aid to CCL by 4/4/22.
There are no citations issued during today's inspection.
Notice of Site Visit was provided and must be posted for 30 days.
Exit interview conducted and report reviewed with Afi Fiaxe.
SUPERVISOR'S NAME:
Sherelle Johnson
TELEPHONE:
(510) 622-2592
LICENSING EVALUATOR NAME:
Cherie Acosta
TELEPHONE:
(510) 622-1623
LICENSING EVALUATOR SIGNATURE:
DATE:
03/02/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/02/2022
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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