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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010210068
Report Date: 11/22/2022
Date Signed: 11/22/2022 04:49:35 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/22/2022 04:49 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:DUCK'S NEST - BERKELEYFACILITY NUMBER:
010210068
ADMINISTRATOR:SINIAN KERAMATIFACILITY TYPE:
850
ADDRESS:1411 - 4TH STREETTELEPHONE:
(510) 527-2331
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:91CENSUS: 0DATE:
11/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Keramati SinianTIME COMPLETED:
02:00 PM
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Attempted Unannounced Required 1 Year Annual Inspection.

Licensing Program Analyst (LPA) LPA Domantay arrived unannounced at the facility at 1:30pm on 11/22/2022 to conduct a visit to conduct unannounced required 1 year annual inspection. LPA attempted to ring the door bell at the front gate of facility 3 times, but no answer. LPA attempted to contact facility at 510-527-2331, but no answer. LPA did not observe or hear any staff or children present at facility during attempted visit. LPA will conduct annual at a later time.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Melissa DomantayTELEPHONE: 510-725-7021
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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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