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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422461
Report Date: 04/06/2021
Date Signed: 06/03/2021 02:59:51 PM

Document Has Been Signed on 06/03/2021 02:59 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:GOLDEN GATE LEARNING CENTERFACILITY NUMBER:
013422461
ADMINISTRATOR:TABIQUE, MELISSAFACILITY TYPE:
850
ADDRESS:1450 SIXTH STTELEPHONE:
(510) 366-9260
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 45TOTAL ENROLLED CHILDREN: 0CENSUS: 18DATE:
04/06/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Melissa TabiqueTIME COMPLETED:
02:30 PM
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THIS IS AN AMENDED REPORT OF THE ORIGINAL REPORT DATED 04/06/2021.

On 04/06/2021, Licensing Program Analyst (LPA) Brittany Newton conducted an unannounced case management visit for the purpose of verifying an assistant is fingerprint cleared and associated. LPA was met by the director Melissa Tabique. Present for the inspection was 8 infants and 10 preschoolers.

LPA searched in guardian and found clearances for staff member S. Licea.




Exit interview conducted, appeal rights provided, and a copy of this report was left with the facility.

A notice of site visit was given and licensee was reminded that it must remain posted for 30 days.

*Signature from facility will be on file.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Newton
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2021
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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Document is an Amendment of Original Document on 06/03/2021 02:51 PM


Created By: Brittany Newton On 04/06/2021 at 01:28 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GOLDEN GATE LEARNING CENTER
FACILITY NUMBER: 013422461

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed




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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Brittany Newton
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2021


LIC809 (FAS) - (06/04)
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