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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214881
Report Date: 02/12/2024
Date Signed: 02/12/2024 01:00:06 PM

Document Has Been Signed on 02/12/2024 01:00 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:BUSD - HOPKINS STREETFACILITY NUMBER:
010214881
ADMINISTRATOR:ROBINSON, K & CARRIEDO, M.FACILITY TYPE:
850
ADDRESS:1810 HOPKINS STREETTELEPHONE:
(510) 644-8939
CITY:BERKELEYSTATE: CAZIP CODE:
94707
CAPACITY: 140TOTAL ENROLLED CHILDREN: 140CENSUS: 31DATE:
02/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Madeleine RoginTIME COMPLETED:
01:14 PM
NARRATIVE
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On February 12, 2024 at 9:05am Licensing Program Analyst (LPA) Indira Loza met with Interim Director Madeleine Rogin for a case management visit. There were 31 children and 14 staff present during today's visit.

The purpose of the visit was due to a self reported incident that was sent to the Oakland Regional office. LPA conducted staff and children interviews.

No deficiencies were cited during today's visit.

Exit interview conducted.
A copy of the report and appeal rights provided to Interim Director Madeleine Rogin.
Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2024
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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