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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408248
Report Date: 11/29/2021
Date Signed: 11/29/2021 12:04:21 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:YMCA OF THE EAST BAY - 8TH STREET CDCFACILITY NUMBER:
073408248
ADMINISTRATOR:KARLA SPARKS-HUNTERFACILITY TYPE:
830
ADDRESS:445 8TH STREET CDCTELEPHONE:
(510) 848-9092
CITY:RICHMONDSTATE: CAZIP CODE:
94801
CAPACITY:36CENSUS: 28DATE:
11/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:Arlene CarilloTIME COMPLETED:
12:18 PM
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Licensing Program Analyst (LPA) Caroline Colson met with Arlene Carillo, Acting Center Director, to conduct a case management inspection at 10:27 AM. The purpose of the inspection is to provide a copy of the November 19, 2021 Facility Evaluation Report because a consistency check occurred during the inspection.

There were no deficiencies cited during this inspection.

Notice of Site Visit
A notice of site visit was given and must remain posted for 30 days.

Exit Interview

Exit interview conducted and report was reviewed with facility representative, Arlene Carillo.

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline ColsonTELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
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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