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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408344
Report Date: 06/14/2023
Date Signed: 06/14/2023 02:40:04 PM


Document Has Been Signed on 06/14/2023 02:40 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:GALVEZ, NYISHAFACILITY NUMBER:
073408344
ADMINISTRATOR:GALVEZ, NYISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 417-2460
CITY:RICHMONDSTATE: CAZIP CODE:
94803
CAPACITY:14CENSUS: 0DATE:
06/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:GALVEZ, NYISHA TIME COMPLETED:
02:45 PM
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On June 14, 2023 at 1:25 PM Licensing Program Analyst (LPA) Nyeesha Blount conducted an unannounced case management inspection for an Unusual incident report that was reported on May 2, 2023. LPA met with licensee Galvez, Nyisha there were no children present today during inspection due to being on break for the week returning Monday June 19, 2023. Licensee stated the occurrence happened at her son's school (School of the Madeleine in Berkeley, Ca). A child choked her son and threatened to come to his home and kill him and his whole family. Licensee advised the principal and Father Nicolas that is over the church, Dioceses in Oakland, Ca also filing a police report with Berkeley Police Department Case# 23-21128 with Officer Muniz Badge # 30 officer stated he added (24) families based on Licensee statement. Licensee has verified she has a total of (24) families enrolled at her facility including drop ins, ( that she gets twice a year) and part time that do not come all at the same time, Licensee stated she stays in Ratio compliance of what her license allows her to have which will be a Large Family Child Care for (14) Children with her (2) assistants. Licensee is having to utilize an attorney to rectify her situation.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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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