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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013410074
Report Date: 04/03/2024
Date Signed: 04/03/2024 04:30:31 PM


Document Has Been Signed on 04/03/2024 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:ECOLE BILINGUE DE BERKELEY PRESCHOOLFACILITY NUMBER:
013410074
ADMINISTRATOR:BURNETT, CHAUNCEYFACILITY TYPE:
850
ADDRESS:2830 TENTH ST.TELEPHONE:
(510) 549-3867
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:100CENSUS: 75DATE:
04/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:Chauncey BurnettTIME COMPLETED:
04:45 PM
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On April 3, 2024 at 10:35am, Licensing Program Analyst (LPA) Indira Loza met with Chauncey Burnett. The purpose of the visit was due to a self reported incident that was received in the Oakland Regional office on 3/27/24. The incident is assigned to an investigator at the Investigations Bureau (IB) who will return to conduct the investigation.

Exit interview conducted.
A copy of the report and appeal rights provided to Director Chauncey Burnett.
Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024
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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