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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407991
Report Date: 06/03/2022
Date Signed: 06/03/2022 10:53:10 AM

Document Has Been Signed on 06/03/2022 10:53 AM - 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:TAYE, YEMSRACHFACILITY NUMBER:
073407991
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
06/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:04 AM
MET WITH:Yemsrach TayeTIME COMPLETED:
11:07 AM
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On Friday, June 3, 2022 at 9:54 AM, Licensing Program Analyst (LPA) Caroline Colson met with Yemsrach Taye, her adult daughter, Tadessa Imobersteg for an unannounced Case Management inspection. There are two (2) infants and three (3) preschool children present. The purpose of this inspection is to obtain copies of the corrections. Licensee was unable to send all of the pictures due to technical difficulties. All deficiencies have been corrected.

There were no deficiencies cited during this inspection. Exit Interview was conducted. Appeal Rights were given.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2022
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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