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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414785
Report Date: 07/12/2023
Date Signed: 07/12/2023 09:57:30 AM

Document Has Been Signed on 07/12/2023 09:57 AM - 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:PURNELL, DEVVINFACILITY NUMBER:
013414785
ADMINISTRATOR:PURNELL, DEVVINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 708-0797
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
07/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Devvin PurnellTIME COMPLETED:
09:57 AM
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On July 12, 2023 at 9:28am Licensing Program Analyst (LPA) Indira Loza arrived unannounced for the purpose of delivering an amended appeal with the date corrected. LPA met with Licensee Devvin Purnell, present for the visit were four preschool age children.

There were no deficiencies cited during today's visit.

Notice of Site visit and Appeal Rights provided to Licensee.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2023
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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