<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211122
Report Date: 05/16/2023
Date Signed: 05/16/2023 04:30:23 PM

Document Has Been Signed on 05/16/2023 04:30 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:MODEL SCHOOL COMPREHENSIVE HUMANISTIC LEARNING CTRFACILITY NUMBER:
010211122
ADMINISTRATOR:YVONNE STEENFACILITY TYPE:
830
ADDRESS:2330 PRINCE STREETTELEPHONE:
(510) 549-2711
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 7DATE:
05/16/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:41 PM
MET WITH:MARIA DUMANTIME COMPLETED:
04:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/16/23, Licensing Program Analyst (LPA) Melissa Domantay arrived at the facility for an unannounced case management inspection to remeasure infant classroom and crib area at the 2330 Prince Street Berkeley, Ca 94705 location. LPA met with Head Infant Teacher, Maria Duman. Present for today's inspection were 7 infants and 3 staff. The normal hours of operation are Monday-Friday 7:00am-6:00pm. LPA conducted a tour of all the infant classroom to conduct a health and safety inspection with Head Teacher, Maria. 1 classroom, the Angelfish Classroom will be utilized for infant program. LPA observed 5 cribs during today's visit. The measurements are as follows:

Infant classroom: 245.43 Square Feet, equals to 7 infants.

LPA received fire clearance from the Berkeley Fire Department, approving for 13 infants, 0-24 months of age.

Infant license for a capacity of 7 infants is pending until infant classroom crib area is set up with barricade between cribs and classroom play area. There are no deficiencies being cited today. A Notice of Site inspection was provided to Head Teacher, Maria and an exit interview was conducted.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1