<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013411184
Report Date: 06/01/2023
Date Signed: 06/01/2023 05:11:19 PM

Document Has Been Signed on 06/01/2023 05:11 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:CHAIREZ, MARIAFACILITY NUMBER:
013411184
ADMINISTRATOR:CHAIREZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 524-5012
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
06/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:17 PM
MET WITH:Maria ChairezTIME COMPLETED:
05:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On June 1, 2023 at 2:17pm, Licensing Program Analysts (LPA) Indira Loza met with Licensee Maria Chairez for an Unannounced Required Annual Inspection. There were two infants, 10 preschool age children,and two additional fingerprint cleared Assistants. The ratio requirement was being met today. The home was toured for a health and safety inspection. The facility operates from 8:00AM – 5:00PM Monday through Friday.

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

Exit Interview conducted with Licensee Chairez
Appeal Rights, Notice of Site visit, and report provided to Licensee Maria Chairez.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6