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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010215940
Report Date: 07/03/2023
Date Signed: 07/03/2023 03:36:33 PM

Document Has Been Signed on 07/03/2023 03:36 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:NEW SCHOOL OF BERKELEY, THEFACILITY NUMBER:
010215940
ADMINISTRATOR:MOORE, AKIMASAFACILITY TYPE:
850
ADDRESS:1606 BONITATELEPHONE:
(510) 548-9165
CITY:BERKELEYSTATE: CAZIP CODE:
94709
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 20DATE:
07/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Merlyn KatechisTIME COMPLETED:
03:30 PM
NARRATIVE
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On 07/3/23, Licensing Program Analyst (LPA) Melissa Domantay arrived unannounced on a case management inspection as a result of 2 children left unsupervised behind a shed led to inappropriate conduct. LPA met with Secretary, Merlyn Katechis. There were 20 children and 12 staff present at the facility. A tour of the facility was conducted to ensure the Health and Safety of children in care. LPA conducted children's file review during today's inspection.

All required forms are posted on the Facility's parent board.

See 809-D for the Type A deficiency.

Exit interview conducted with Secretary, Merlyn Katechis. A copy of this report was provided to licensee.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2023
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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Document Has Been Signed on 07/03/2023 03:36 PM - It Cannot Be Edited


Created By: Melissa Domantay On 07/03/2023 at 11:46 AM
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: NEW SCHOOL OF BERKELEY, THE
FACILITY NUMBER: 010215940

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/05/2023
Section Cited
CCR
101223(a)(1)

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101223(a)(1) The licensee shall ensure that each child is accorded the following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons.This requirement has not been met as evidenced by:
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By 7/5/23, Director shall create a plan on how staff will supervise children indoor and outdoors to ensure all areas will be visble and supervised by a staff member. Director shall conduct a meeting with staff about personal rights and supervision. Director shall submit meeting minutes and staff attendance to LPA.
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Based on staff and parent interviews. 2 children left unsupervised behind a shed led to inappropriate conduct.
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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:Melissa Domantay
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2023


LIC809 (FAS) - (06/04)
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