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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013410074
Report Date: 03/22/2024
Date Signed: 03/22/2024 04:23:01 PM

Document Has Been Signed on 03/22/2024 04:23 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:BURNETT, CHAUNCEYFACILITY TYPE:
850
ADDRESS:2830 TENTH ST.TELEPHONE:
(510) 549-3867
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 59DATE:
03/22/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Chauncey BurnettTIME COMPLETED:
04:35 PM
NARRATIVE
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On March 22, 2024 at 10:50am Licensing Program Analyst (LPA) Indira Loza met with Director Chauncey Burnett for an unannounced Case Management visit. Present during today's visit were 74 children and 10 staff. LPA conducted a tour for a health and safety check.

A case management was conducted because the center did not test the water used for drinking and/or food preparation. According to the Written Directives, all centers constructed before 2010 were to have the water outlets used for drinking and/or food preparation tested by January 1, 2023.

See LIC809-D for the Type B citation.

Exit Interview Conducted.
Report and Appeal Rights were reviewed and provided to Chauncey Burnette.
Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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 03/22/2024 04:23 PM - It Cannot Be Edited


Created By: Indira Loza On 03/22/2024 at 03:10 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: 03/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/22/2024
Section Cited

100700(c)(1)

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(a) Effective July 28 2021, a Child Care Center, as defined in section 101152 of
Title 22 of the California Code of Regulations, shall, in addition to the
provisions of Division 12 of Title 22, be governed by these written directives.
(b) All licensed Child Care Centers operating in buildings constructed before
January 1, 2010, shall test their water for lead pursuant to these written directives.
(c) For a license issued prior to July 1,
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The Director shall arrange for the testing of all water outlets used for food preparation and/or drinking, no later than April 22, 2024.
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received and posted prior to January 1,
2023. This requirement was not met 2022, initial testing results of water outlets
described in section 101701 shall be as evidenced by: Based on interview and record review it was determined that the center did not have the water used for drinking and/or food preparation tested for lead; which poses a potential Health, Safety, or Personal Rights risk 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.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2024


LIC809 (FAS) - (06/04)
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