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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418198
Report Date: 04/27/2021
Date Signed: 04/27/2021 01:51:59 PM

Document Has Been Signed on 04/27/2021 01:51 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:JEWISH COMMUNITY CTR OF THE EAST BAY-BERKELEYFACILITY NUMBER:
013418198
ADMINISTRATOR:SHORER, RUTHFACILITY TYPE:
850
ADDRESS:1414 WALNUT STREETTELEPHONE:
(510) 848-0237
CITY:BERKELEYSTATE: CAZIP CODE:
94709
CAPACITY: 75TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
04/27/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Ruther Shorer and Aaron AtlasTIME COMPLETED:
02:00 PM
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On 04/27/2021, Licensing Program Analyst (LPA) Brittany Newton conducted an unannounced case management visit regarding an incident report received in our office on 04/26/2021.

LPA conducted interviews.

Further investigation is still needed at this time.


No deficiencies cited at this visit. A copy of this report was left with Director Ruth Shorer and Chief Operating Officer Aaron Atlas.

Notice of site visit provided and must be posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Newton
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2021
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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