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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211909
Report Date: 07/29/2019
Date Signed: 07/29/2019 01:46:54 PM

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:BAHIA SCHOOL AGE PROGRAMFACILITY NUMBER:
010211909
ADMINISTRATOR:LEVYA-CUTLER,B.&CUEVA, M.FACILITY TYPE:
840
ADDRESS:1718 - 8TH STREETTELEPHONE:
(510) 524-7300
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:65CENSUS: 40DATE:
07/29/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Beatriz Leyva-CutlerTIME COMPLETED:
01:50 PM
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LPA Dayna Collier met with Center Director Beatriz Leyva-Cutler for a case management inspection as a result of receiving an unusual incident report. Present for the inspection were 7 staff members and 40 school age children present.

As a result of this inspection, there were no deficiencies cited.

A site visit notice was posted by the Director.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2019
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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