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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010211909
Report Date: 08/30/2023
Date Signed: 08/30/2023 04:54:15 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2023 and conducted by Evaluator Indira Loza
COMPLAINT CONTROL NUMBER: 02-CC-20230811133057
FACILITY NAME:BAHIA SCHOOL AGE PROGRAMFACILITY NUMBER:
010211909
ADMINISTRATOR:LEVYA-CUTLER,B.&CUEVA, M.FACILITY TYPE:
840
ADDRESS:1718 - 8TH STREETTELEPHONE:
(510) 524-7300
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:65CENSUS: 14DATE:
08/30/2023
UNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Yanci LuceroTIME COMPLETED:
05:03 PM
ALLEGATION(S):
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Personal Rights - Lack of Care and Supervision
INVESTIGATION FINDINGS:
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On August 30, 2023 at 1:43pm Licensing Program Analyst (LPA) Indira Loza arrived unnannounced to continue the complaint investigation for the above allegation. LPA conducted a tour of the facility for a health and safety check.

During the course of the investigation LPA Loza conducted parent, staff, and children interviews, toured the facility, and collected a children's roster. Based on the interviews conducted it has been determined that a child was able to run away from the facility and cross the street. The preponderance of evidence standard has been met and the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on LIC 9099-D page. The Director shall post a copy of this report in a location where all parents can easily view it and provide an Acknowledgement of Receipt of Licensing Reports (LIC 9224) to all parents of currently enrolled children, and children enrolled after 12 months today's date. The Director shall also maintain the signed forms in the children's files for the next twelve months from today's date.
*******************************************Report Continues on LIC9099 - C********************************************
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 02-CC-20230811133057
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: BAHIA SCHOOL AGE PROGRAM
FACILITY NUMBER: 010211909
VISIT DATE: 08/30/2023
NARRATIVE
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Report and Appeal Rights reviewed with Site Supervisor Yanci Lucero.
A Notice of Site Visit was given and must remain posted for 30 days along with this report.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20230811133057
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: BAHIA SCHOOL AGE PROGRAM
FACILITY NUMBER: 010211909
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/31/2023
Section Cited
CCR
101223(a)(2)
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Personal Rights - (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not as evidenced by:
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The Director shall submit a plan for ensuring that no children are able to leave the premises without authorization.
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Based on interviews it was determined that a child was able to run out of the facility, down the street, and cross the street by themselves, which poses an immediate risk to the Health, Safety, and Personal Rights to the 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.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3