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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211909
Report Date: 08/15/2024
Date Signed: 08/15/2024 05:12:23 PM

Document Has Been Signed on 08/15/2024 05:12 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:BAHIA SCHOOL AGE PROGRAMFACILITY NUMBER:
010211909
ADMINISTRATOR/
DIRECTOR:		LUCERO, YANCIFACILITY TYPE:
840
ADDRESS:1718 - 8TH STREETTELEPHONE:
(510) 524-7300
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 65TOTAL ENROLLED CHILDREN: 65CENSUS: 18DATE:
08/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Yanci LuceroTIME VISIT/
INSPECTION COMPLETED:
05:25 PM
NARRATIVE
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On August 15, 2024 at 3:15pm Licensing Program Analyst (LPA) Indira Loza met with Director Yanci Lucero to continue an investigation for a self reported unusual incident received in the Oakland Regional Office on July 18, 2024. Present during the visit were 18 school-age children and 6 fingerprint cleared staff. LPA toured the center for a health and safety check.

LPA conducted staff and children interviews which revealed that the a staff person had grabbed several children by their wrists, squeezed their arm, and pulled the children. Interviews also stated that the same staff person would withhold food and would hold children by their wrist if they were not listening. Therefore, California Code of Regulations (CCR) 101223(a)(3) is being cited with a Type A deficiency.

LPA informed the Director to provide a copy of this licensing report dated 8/15/2024 that documents one Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

See LIC809-D for deficiency.

Exit interview conducted.
A copy of the report and appeal rights provided to Director Yanci Lucero.
Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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 08/15/2024 05:12 PM - It Cannot Be Edited


Created By: Indira Loza On 08/15/2024 at 04:54 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: BAHIA SCHOOL AGE PROGRAM
FACILITY NUMBER: 010211909

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/16/2024
Section Cited
CCR
101223(a)(3)

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(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing... This
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The Director shall email the LPA a plan detailing how they will prevent these methods of punishment form occurring again. This plan shall be emailed ot the LPA no later than August 16, 2024.
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requirement was not met as evidenced by: Based on interviews it has been determined that a staff person grabbed children by the wrist, withheld food, squeezed children's arms 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: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2024


LIC809 (FAS) - (06/04)
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