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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073402350
Report Date:
12/02/2022
Date Signed:
12/02/2022 02:48:49 PM
Document Has Been Signed on
12/02/2022 02:48 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 CHILD START - LOS ARBOLES
FACILITY NUMBER:
073402350
ADMINISTRATOR:
ENTESAR(SARAH)EBEID
FACILITY TYPE:
850
ADDRESS:
240 LAS DUNAS
TELEPHONE:
(925) 427-8930
CITY:
OAKLEY
STATE:
CA
ZIP CODE:
94561
CAPACITY:
24
TOTAL ENROLLED CHILDREN:
16
CENSUS:
9
DATE:
12/02/2022
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
01:15 PM
MET WITH:
Entesar (Sarah) Ebeid
TIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management visit to follow up on a self reported incident. LPA met with Site Supervisor Entesar (Sarah) Ebeid. There were 9 children and 5 staff present during the visit.
During the visit LPA conducted interview and reviewed a video.
There are no deficiencies cited during today's visit.
Notice of site visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Entesar (Sarah) Ebeid
SUPERVISORS NAME
:
Sherelle Johnson
LICENSING EVALUATOR NAME
:
Cherie Acosta
LICENSING EVALUATOR SIGNATURE
:
DATE:
12/02/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/02/2022
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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