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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421354
Report Date: 05/03/2024
Date Signed: 05/03/2024 03:44:15 PM

Document Has Been Signed on 05/03/2024 03:44 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:MI MUNDO PRESCHOOLFACILITY NUMBER:
013421354
ADMINISTRATOR/
DIRECTOR:		LOPEZ, LINAFACILITY TYPE:
850
ADDRESS:1866 ALCATRAZ AVETELEPHONE:
(510) 395-4614
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY: 29TOTAL ENROLLED CHILDREN: 29CENSUS: 18DATE:
05/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:37 AM
MET WITH:LOPEZ, LINA TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On April 3, 2024 at 8:30AM Licensing Program Analyst (LPA) Nyeesha Blount conducted an unannounced case management visit in regards to an incident that was reported to our Regional Office on May 1, 2024. LPA met with Director Munoz, Julieta and Administrator Lopez, Lina present during the inspection were (2) staff members, (18) preschool children. An incident occurred in the facility where a child stated to parents he was touched by (2) children.


No deficiencies were sited during today's visit. Exit interview was conducted.
Report was reviewed and a copy was provided to Administrator Lopez, Lina along with appeal rights and Notice of Site Visit was given.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2024
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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