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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073408218
Report Date:
06/04/2021
Date Signed:
06/04/2021 03:13:30 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:
EAST BAY WALDORF SCHOOL
FACILITY NUMBER:
073408218
ADMINISTRATOR:
GERHARDT, AVERY
FACILITY TYPE:
850
ADDRESS:
3800 CLARK RD.
TELEPHONE:
(510) 223-3570
CITY:
EL SOBRANTE
STATE:
CA
ZIP CODE:
94803
CAPACITY:
35
CENSUS:
0
DATE:
06/04/2021
TYPE OF VISIT:
Case Management - Other
ANNOUNCED
TIME BEGAN:
01:45 PM
MET WITH:
Loveleen Dhillon
TIME COMPLETED:
03:25 PM
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An announced Case Management site visit was conducted by LPM Mayla Mendoza and LPA Melissa Domantay as requested by Lead Teacher Loveleen Dhillon.
No deficiencies were observed. An exit interview was made with Ms. Dhillon.
SUPERVISOR'S NAME:
Diane Perez
TELEPHONE:
(510) 622-2590
LICENSING EVALUATOR NAME:
Mayla Mendoza
TELEPHONE:
(510) 873-6408
LICENSING EVALUATOR SIGNATURE:
DATE:
06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/04/2021
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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