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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010200115
Report Date: 07/25/2024
Date Signed: 07/25/2024 03:19:44 PM

Document Has Been Signed on 07/25/2024 03:19 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:CHILDRENS COMMUNITY CENTERFACILITY NUMBER:
010200115
ADMINISTRATOR/
DIRECTOR:		KATHY CHEWFACILITY TYPE:
850
ADDRESS:1140 WALNUT STTELEPHONE:
(510) 528-6975
CITY:BERKELEYSTATE: CAZIP CODE:
94707
CAPACITY: 52TOTAL ENROLLED CHILDREN: 52CENSUS: DATE:
07/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Alyssa AdairTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
NARRATIVE
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On July 25, 2024 at 11:40am Licensing Program Analyst (LPA) Indira Loza met with Co-Director Alyssa Adair. The purpose of the visit was due to a self reported incident that was received at the Oakland Regional office. Present during the visit were 29 children and 7 fingerprint cleared staff. LPA walked through the facility for a health and safety check.

LPA interviewed staff and children regarding the incident that occurred in the facility on July 10, 2024, where a child opened the gate that exits the facility. Staff and children were interviewed and it was stated that the child was able to exit the classroom and go to the off limit area by reaching over the short gate, and opening the door. Once the child got through the door, they got to the second door (which is an exit to the sidewalk) and was able to open the door. A staff person was entering the facility at that moment, and was able to stop the child from exiting the facility. This is a violation of the California Code of Regulations (CCR) Title 22 101229(a)(1), which is a Type A deficiency and a zero tolerance violation, which carries an immediate Civil Penalty for $500.

The attached type A violation is cited today and must be corrected by the due date of July 26, 2024. Upon receipt, the director shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC9224 must be placed in the child's file to be reviewed by licensing.
See LIC809-D for citation.

Exit interview conducted.
A copy of the report and appeal rights provided to Director Alyssa Adair.
Notice of Site Visit provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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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Document Has Been Signed on 07/25/2024 03:19 PM - It Cannot Be Edited


Created By: Indira Loza On 07/25/2024 at 02:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CHILDRENS COMMUNITY CENTER
FACILITY NUMBER: 010200115

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/26/2024
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met as evidenced by:
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The Direcor shall create a detailed plan to maintain 100% supervision on the children at all times. This plan shall be emailed to the LPA no later than the close of business on 7/26/2024.
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Based on record review and interviews, it has been determined that a child was able to open two doors and almost make it out of the facility, which poses an immediate risk to the health, safety, and personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2024


LIC809 (FAS) - (06/04)
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