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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418318
Report Date: 01/30/2024
Date Signed: 02/07/2024 04:08:47 PM

Document Has Been Signed on 02/07/2024 04:08 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:BARRAZA, CARLOS HFACILITY NUMBER:
013418318
ADMINISTRATOR:BARRAZA, CARLOS HFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 526-4357
CITY:BERKELEYSTATE: CAZIP CODE:
94707
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
01/30/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Carlos BarrazaTIME COMPLETED:
04:25 PM
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This is an Amended report for the report dated January 30, 2024

On January 30, 2024 at 2:40pm Licensing Program Analysts (LPAs) Indira Loza and Janai McClain arrived at the facility for an unannounced required inspection. LPAs met with the Licensee Carlos Barraza. Present during the inspection were the Licensee, Licensee's spouse/Assistant Juan Ojeda, Assistant Arlidys Rodriguez, 3 infants, and 9 preschoolers in care. LPAs conducted a tour of the areas of the home that are used for children in care. The operating hours are 7:30am to 5:30pm Monday through Friday.

Due to time constraints the annual inspection will be continued at a later date.

Exit Interview conducted with Licensee.
Appeal Rights, Notice of Site visit, and report provided to Licensee Carlos Barraza.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
VISIT DATE: 01/30/2024
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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 11
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
VISIT DATE: 01/30/2024
NARRATIVE
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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
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