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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420548
Report Date: 09/12/2024
Date Signed: 09/12/2024 12:23:31 PM

Document Has Been Signed on 09/12/2024 12:23 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:UCB - UNIVERSITY VILLAGE ECEPFACILITY NUMBER:
013420548
ADMINISTRATOR/
DIRECTOR:		LAUREANA MEDRANOFACILITY TYPE:
850
ADDRESS:1123 JACKSON STTELEPHONE:
(510) 642-1827
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 26DATE:
09/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Narges (Shima) Askari TIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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On September 12, 2024 at 9:10am Licensing Program Analyst (LPA) Indira Loza met with Interim Director Narges (Shima) Askari to conduct an unannounced case management in regards to an unusual incident reported to the Oakland Regional Office on August 16, 2024. LPA interviewed Director and staff regarding the incident that occurred and watched video footage of the of the incident. LPA will return to continue the case management.

No deficiencies cited during today's visit.
Exit interview conducted.
A copy of the report and appeal rights provided to Interim Director Narges Askari
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: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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