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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010200607
Report Date: 06/23/2022
Date Signed: 06/23/2022 03:55:01 PM


Document Has Been Signed on 06/23/2022 03:55 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 HEAD START - SOUTH YMCAFACILITY NUMBER:
010200607
ADMINISTRATOR:DORIAN BURNLEYFACILITY TYPE:
850
ADDRESS:2901 CALIFORNIA STREETTELEPHONE:
(510) 848-9092
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY:52CENSUS: DATE:
06/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:42 PM
MET WITH:Dorian Burnley and Birdie WinrowTIME COMPLETED:
03:35 PM
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On June 23, 2022 at 1:42pm Licensing Program Analyst (LPA) Indira Loza and a CDSS attorney arrived at the facility to follow up on a case management inspection that was completed on May 9, 2022 . LPA met with Director Dorian Burnley, Area Manager Birdie Winrow, Executive Director Melanie Mueller . There were 4 staff and 16 Children present.

As a result there were no deficiencies cited during today’s visit. Appeal Rights and notice of site visit was given to Area Manager Birdie Winrow.

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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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