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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415554
Report Date: 03/14/2024
Date Signed: 03/14/2024 05:24:06 PM

Document Has Been Signed on 03/14/2024 05:24 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:SANDERS, URSULAFACILITY NUMBER:
013415554
ADMINISTRATOR:SANDERS, URSULAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 333-2528
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
03/14/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ursula SandersTIME COMPLETED:
05:20 PM
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On March 14, 2024 at 1:00pm Licensing Program Analysts (LPAs) Indira Loza and Janai McClain met with Licensee Ursula Sanders. Present during today's visit were the Licensee, Licensee's father, Assistant Breanna Jones, and five (5) preschool age children.

The purpose of the visit was due to a self reported incident that was sent to the Oakland Regional office. LPAs interviewed Licensee Ursula Sanders regarding the incident that occurred in the facility.

No deficiencies cited during today's visit.

Exit interview conducted.
A copy of the report and appeal rights provided to Licensee Ursula Sanders.
Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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