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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013410074
Report Date: 05/18/2022
Date Signed: 05/18/2022 02:07:33 PM

Document Has Been Signed on 05/18/2022 02:07 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:ECOLE BILINGUE DE BERKELEY PRESCHOOLFACILITY NUMBER:
013410074
ADMINISTRATOR:MIRZA KOPELMANFACILITY TYPE:
850
ADDRESS:2830 TENTH ST.TELEPHONE:
(510) 549-3867
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 74DATE:
05/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:SABASTIAN ROBERTTIME COMPLETED:
02:30 PM
NARRATIVE
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LICENSING PROGRAM ANALYST TASHA ALEXANDER MET WITH THE HEAD OF THE SCHOOL MR. ROBERT AND ASSISTANT DIRECTOR MS. BURNETT TO CONDUCT A COMPLAINT INVESTIGATION. DURING TODAY'S INTERVIEWS IT WAS DISCOVERED THAT THE FACILITY DID NOT REPORT THE INCIDENT TO COMMUNITY CARE LICENSING BY PHONE CALL OR SUBMITTING THE UNUSUAL INCIDENT REPORT WITHIN 7 DAYS. PER HEAD OF SCHOOL, THE REPORT WAS SENT BY MAIL. IT IS NOTED THAT AS OF TODAY 5/18/22 THE REPORT HAS NOT BEEN RECEIVED BY COMMUNITY CARE LICENSING AS YET.

PER TITLE 22 REGULATIONS, THE FACILITY SHALL REPORT TO COMMUNITY CARE LICENSING AN UNUSUAL INCIDENT BY TELEPHONE, WITHIN 24 HOURS OF THE INCIDENT HAPPENING AND SUBMIT THE UNUSUAL INCIDENT REPORT BY FAX OR MAIL WITHIN 7 DAYS.

PLEASE SEE ATTACHED 809-D FOR CITATION


AN EXIT INTERVIEW WAS CONDUCTED. THIS REPORT SHALL BE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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 05/18/2022 02:07 PM - It Cannot Be Edited


Created By: Tasha Hackett-Alexander On 05/18/2022 at 01:42 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: ECOLE BILINGUE DE BERKELEY PRESCHOOL
FACILITY NUMBER: 013410074

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/19/2022
Section Cited
CCR
101212(a)(d)

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101212 Reporting Requirements
a) Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following:
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
(1) Events reported shall include the following: (D) Any suspected physical or psychological abuse of any child.
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FACILITY SHALL ENSURE THAT ANY UNUSUAL INCIDENT THAT OCCURS AT THE FACILITY AND IN THE PRESENCE OF CHILDREN IN CARE SHALL BE REPORTED TO COMMUNITY CARE LICENSING BY PHONE WITHIN 24 HOURS OF THE INCIDENT AND SUBMIT THE UNUSUAL INCIDENT REPORT WITHIN 7 DAYS.
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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:Loretta Dyson
LICENSING EVALUATOR NAME:Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022


LIC809 (FAS) - (06/04)
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