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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206120
Report Date: 04/24/2024
Date Signed: 04/24/2024 04:47:19 PM

Document Has Been Signed on 04/24/2024 04:47 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/
DIRECTOR:		CARLOTA HERNANDEZ DE CRUZFACILITY TYPE:
850
ADDRESS:2009 10TH STREETTELEPHONE:
(510) 848-9092
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 70TOTAL ENROLLED CHILDREN: 29CENSUS: 0DATE:
04/24/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Gloria Cross-BrookTIME VISIT/
INSPECTION COMPLETED:
04:55 PM
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On April 24, 2024 at 2:15pm, Licensing Program Analyst (LPA) Indira Loza met with Director Gloria Cross-Brook for an Unannounced Annual/Random Inspection. There were no children in care during today's visit. The center was toured for a health and safety inspection and operating hours are 7:30am – 5pm, Monday through Friday.

Due to time constraints the annual inspection will be continued at a later date.

Exit Interview conducted.
Appeal Rights and report provided to Director Cross-Brook.
Notice of Site visit must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
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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