010211112-5-12-2023-02-CC-DCAS-CRRTST-20230512145939

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010211112
Report Date: 05/12/2023
Date Signed: 05/12/2023 02:59:51 PM

Document Has Been Signed on 05/12/2023 02:59 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 CTR		FACILITY NUMBER:	010211112
ADMINISTRATOR:	SALIH, NAGWA		FACILITY TYPE:	850
ADDRESS:	2330 PRINCE STREET		TELEPHONE:	(510) 549-2711
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94705
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 40	CENSUS: 23	DATE:	05/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Nagwa Salih		TIME COMPLETED:	03:00 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 05/12/2023 at 09:00 AM Licensing Program Analyst (LPA) Diana Campos arrived for an unannounced Annual Required Inspection at Model School Comprehensive Humanistic Learning Center. LPA met with Center Director, Nagwa Salih and explained the purpose of today's inspection. LPA was granted inspection authority to enter the facility. The facility was toured to conduct a Health and Safety Inspection. Facility's operating days and hours are Monday-Friday 7:30 AM-6:00 PM. The physical plant was inspected. LPA toured the premises with the Director. Indoor space: Facility operates in 2 Rooms - Jellyfish Classroom (preschool) and Sea Stars (toddler component). Jellyfish Classroom (Preschool): 1 teacher and 1 Teacher Aid with 14 children Sea Stars Classroom (Toddler Component): 1 teacher and 1 Teacher Aid with 9 children Facility was observed to be in compliance with teacher to children ratio requirement during LPA’s inspection. The classrooms, restrooms, food storage areas and spaces accessible to children were inspected. Disinfectants, cleaning solutions, poisons and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Storage areas for poisons were locked and medications were kept in a safe place inaccessible to children. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed, all toilets, and hand washing sinks are in operating condition. All floors were clean and safe. Foods and beverages were stored safely. Food storage area was clean, free of litter, rubbish, and free of rodents and other vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair. LPA observed at least 2 fully charged 3A40BC Fire extinguishers, Smoke and Carbon Monoxide Detectors. All materials and surfaces accessible to children appeared to be toxic free. Facility provides morning and afternoon snacks for children and snack menus were observed to be posted in a place visible by the child’s authorized representative.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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: MODEL SCHOOL COMPREHENSIVE HUMANISTIC LEARNING CTR	FACILITY NUMBER: 010211112
	VISIT DATE: 05/12/2023

NARRATIVE

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Outdoor Space: Outdoor playground was inspected and observed to be fenced.
Some of the play equipment was in need of minor repairs. Surface of the outdoor activity space needs minor maintenance. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls, however some of the squares are detaching and will need to be re-attached or replaced to avoid a hazard to day care children. There were no bodies of water observed. Drinking water is readily available to children during indoor and outdoor activities.

File Review: Children sign in and out procedures and logs were reviewed. All children were signed in by their authorized representative electronically. A sample of five 7 Children's files and Staff files were taken for review.

Center Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the center Director Nagwa Salih.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/12/2023 02:59 PM - It Cannot Be Edited

Created By: Diana Campos On 05/12/2023 at 02:31 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: MODEL SCHOOL COMPREHENSIVE HUMANISTIC LEARNING CTR	FACILITY NUMBER: 010211112
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238.2(d)

Outdoor Activity Space

(d) The surface of the outdoor activity space shall be maintained: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that outdoor play surface area requires maintenance on the following items: detached black cushion tile around play structure, chipped paint on play structures, loose wobbly play structure parts, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/12/2023
	Plan of Correction
1 2 3 4	by POC date facility shall submit to licensing proof of repairs and maintenance completed in the outdoor play area.

Type B

Section Cited

CCR

101226(e)(3)(B)1

Health-Related Services

(3) Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child. 1. This documentation shall be kept in the child's record. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above in that at least one child's medication form was not available for review during today's inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/12/2023
	Plan of Correction
1 2 3 4	By POC date facility shall submit to licensing a copy of the documentaion for approval and instructions from child's authorized representative regarding administration of presc. medication.

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:

Sherelle Johnson

LICENSING EVALUATOR NAME:

Diana Campos

LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC809 (FAS) - (06/04)

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