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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206120
Report Date: 03/09/2023
Date Signed: 03/09/2023 12:25:42 PM

Document Has Been Signed on 03/09/2023 12:25 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:BERKELEY YMCA HEAD START - WESTFACILITY NUMBER:
010206120
ADMINISTRATOR:MURRAY, CHERYLFACILITY TYPE:
850
ADDRESS:2009 10TH STREETTELEPHONE:
(510) 848-9092
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: DATE:
03/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Carlota Hernandez De CruzTIME COMPLETED:
12:24 PM
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On March 9, 2023 at 9:00am Licensing Program Analyst (LPA) Indira Loza and Licensing Program Manager (LPA) Mayla Mendoza met with Director Carlota Hernandez De Cruz to continue an investigation for an Unusual Incident that was reported to the Oakland Regional Office on February 24, 2023.

A staff person allegedly hit a child. LPA and LPM reviewed records, watched video footage, and conducted staff and children interviews, which did not indicate the staff hit the child.

There was no citation issued.
Exit Interview conducted with Director Carlota Hernandez De Cruz.
Report and Appeal Rights provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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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