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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
010206120
Report Date:
12/14/2021
Date Signed:
12/14/2021 11:49:52 AM
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 - WEST
FACILITY NUMBER:
010206120
ADMINISTRATOR:
MURRAY, CHERYL
FACILITY TYPE:
850
ADDRESS:
2009 10TH STREET
TELEPHONE:
(510) 848-9092
CITY:
BERKELEY
STATE:
CA
ZIP CODE:
94710
CAPACITY:
70
CENSUS:
16
DATE:
12/14/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:20 AM
MET WITH:
Munal Musaid and Lana Davila
TIME COMPLETED:
12:00 PM
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An unannounced Case Management site visit was conducted by Licensing Program Manager (LPM) Mayla Mendoza and Regional Manager (RM) Diane Perez in regards to a clearance status on a staff member. LPM and RM met with Head Teacher Munal Musaid and Family Advocate Lana Davila. Staff person was not present and neither was Director Cheryl Murray.
Exit interview conducted and report was reviewed with Head Teacher Munal Musaid and Lana Davila.
SUPERVISOR'S NAME:
Diane Perez
TELEPHONE:
(510) 622-2590
LICENSING EVALUATOR NAME:
Mayla Mendoza
TELEPHONE:
(510) 873-6408
LICENSING EVALUATOR SIGNATURE:
DATE:
12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/14/2021
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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