<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
013418318
Report Date:
06/17/2022
Date Signed:
06/27/2022 11:19:13 AM
Document Has Been Signed on
06/27/2022 11:19 AM
- 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:
BARRAZA, CARLOS H
FACILITY NUMBER:
013418318
ADMINISTRATOR:
BARRAZA, CARLOS H
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(510) 526-4357
CITY:
BERKELEY
STATE:
CA
ZIP CODE:
94707
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
DATE:
06/17/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:32 AM
MET WITH:
TIME COMPLETED:
11:45 AM
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
SUPERVISORS NAME
:
Mayla Mendoza
LICENSING EVALUATOR NAME
:
Indira Loza
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/17/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/17/2022
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