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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417825
Report Date: 04/07/2023
Date Signed: 04/07/2023 04:28:48 PM

Document Has Been Signed on 04/07/2023 04:28 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:BERKELEY YMCA EHS - VERA CASEYFACILITY NUMBER:
013417825
ADMINISTRATOR:GLORIA CROSS-BROOKSFACILITY TYPE:
830
ADDRESS:2246 MARTIN LUTHER KING JR WAYTELEPHONE:
(510) 542-2146
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 10DATE:
04/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:12 PM
MET WITH:Kathy NugyenTIME COMPLETED:
04:33 PM
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On April 7, 2023 at 12:12 PM, Licensing Program Analyst (LPA) Indira Loza met with Site Supervisor Kathy Nugyen and Area Manager Joshua Jackson for an Unannounced Required Annual Inspection. There were 10 infants and 10 additional fingerprint cleared adults. The teacher/ child ratio was being met today. The center was toured for a health and safety inspection. The facility operates from 7:30AM – 5:00PM Monday through Friday.

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

There were no deficiencies cited during today's visit.
Exit Interview conducted.
Appeal Rights, Notice of Site visit, and report provided to Area Manager Joshua Jackson.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2023
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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