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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212490
Report Date: 06/22/2023
Date Signed: 06/22/2023 12:32:10 PM


Document Has Been Signed on 06/22/2023 12:32 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:UCB - HAROLD E. JONES CHILD STUDY CTR/CHILDCAREFACILITY NUMBER:
010212490
ADMINISTRATOR:IRIS BRADFORDFACILITY TYPE:
850
ADDRESS:2425 ATHERTON STREETTELEPHONE:
(510) 643-5449
CITY:BERKELEYSTATE: CAZIP CODE:
94704
CAPACITY:56CENSUS: 25DATE:
06/22/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Alexander "Sasha" LevatonTIME COMPLETED:
12:41 PM
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On June 22, 2023 at 11:04am, Licensing Program Analyst (LPA) Indira Loza met with Director Alexander "Sasha" Levaton, to conduct an unannounced Licensee Initiated Case Management visit. There were 25 children and ten staff present. LPA conducted a tour of the facility for a health and safety check.

The purpose of the visit was to observe and advise on the a few supervision questions that the facility staff and Director had to ensure they were in compliance with the Title 22 and Title 5 regulations.

There were no deficiencies cited during today's visit.
Exit interview and report was reviewed with the Director.
A notice of Site visit was provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2023
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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