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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420964
Report Date: 01/26/2024
Date Signed: 01/26/2024 09:22:15 AM


Document Has Been Signed on 01/26/2024 09:22 AM - 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:BERKELEY YMCA HEAD START - EMERYVILLE MARINAFACILITY NUMBER:
013420964
ADMINISTRATOR:WILLIAMS, ROCHELLE LA'RUEFACILITY TYPE:
830
ADDRESS:1275 - 61ST STTELEPHONE:
(510) 601-8674
CITY:EMERYVILLESTATE: CAZIP CODE:
94608
CAPACITY:40CENSUS: 15DATE:
01/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Denia DobashiTIME COMPLETED:
09:30 AM
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On January 26, 2024 at 9:00am Licensing Program Analyst (LPA) Diana Campos met with Site Supervisor Denia Dobashi to deliver an amended report dated November 16, 2023. Present during today's visit were 15 children and 10 staff.

No citations were issued as a result of this visit.

Exit interview conducted and report reviewed with Site Supervisor Denia Dobashi.
A Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2024
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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