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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419436
Report Date: 10/13/2023
Date Signed: 10/13/2023 03:28:49 PM


Document Has Been Signed on 10/13/2023 03:28 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:BUSD - FRANKLIN PRESCHOOLFACILITY NUMBER:
013419436
ADMINISTRATOR:CARRIEDO, MARIAFACILITY TYPE:
850
ADDRESS:1460 - 8TH STREETTELEPHONE:
(510) 644-4533
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:192CENSUS: 14DATE:
10/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:04 PM
MET WITH:Madeleine RoginTIME COMPLETED:
03:35 PM
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On October 13, 2023 at 3:02pm Licensing Program Analyst (LPA) Indira Loza met with Interim Principal Madeleine Rogin. There were 14 children and 4 staff present during the visit.

The purpose of the visit was due to a self reported incident that was sent to the Oakland Regional office. The Investigations Bureau conducted interviews.
No deficiencies were cited during today's visit.

Exit interview conducted.
A copy of the report and appeal rights provided to Interim Principal Madeleine Rogin.
Notice of Site Visit provided.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023
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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