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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211112
Report Date: 05/04/2023
Date Signed: 05/04/2023 03:22:52 PM

Document Has Been Signed on 05/04/2023 03:22 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:MODEL SCHOOL COMPREHENSIVE HUMANISTIC LEARNING CTRFACILITY NUMBER:
010211112
ADMINISTRATOR:SALIH, NAGWAFACILITY TYPE:
850
ADDRESS:2330 PRINCE STREETTELEPHONE:
(510) 549-2711
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 33DATE:
05/04/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Yvonne SteenTIME COMPLETED:
03:40 PM
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A Case Management Visit was conducted today 5/4/23 by Licensing Program Analyst (LPA) Melissa Domantay. LPA met with Director, Yvonne Steen. An application was received for a decrease of capacity. The preschool program will operate in 2 Classrooms, called the Jellyfish Classrooms and Toddler program will operate in the Sea Stars Classroom. Hours of operation are Monday-Friday from 7:00AM to 6:00PM. A health and safety inspection was conducted inside and outside and all measurements remain the same from previous pre-licensing visit.

The preschool and toddler rooms are equipped with varied age appropriate materials and equipment. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Trash cans for solid waste had tight-fitting covers on and were in good repair. LPA observed a working Fire extinguisher, Smoke and Carbon Monoxide Detectors. Facility’s License, Parents’ Rights Poster PUB393, Personal Rights, Activity Schedules, and Menus were observed to be posted.

Shared Outdoor playground was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards. Play areas were cushioned with material that absorbs falls. Shade is provided by way of trees. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.

A license for a capacity of 36 Preschoolers and 14 Toddlers, with a total capacity of 50 is effective today. There are no deficiencies cited today. Exit interview conducted and report was reviewed with Director, Yvonne Steen. A Notice of Site Visit was given and must remain posted for 30 consecutive days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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