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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415554
Report Date: 03/14/2024
Date Signed: 03/14/2024 05:25:10 PM

Document Has Been Signed on 03/14/2024 05:25 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:SANDERS, URSULAFACILITY NUMBER:
013415554
ADMINISTRATOR:SANDERS, URSULAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 333-2528
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
03/14/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ursula SandersTIME COMPLETED:
05:30 PM
NARRATIVE
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On March 14, 2024 Licensing Program Analysts (LPAs) Indira Loza and Janai McClain met with Licensee Ursula Sanders. Present during the visit was the Licensee, the Licensee's father, Assistant Breanna Jones, and five (5) preschool age children. The purpose of the visit was due to a self reported incident that was received in the Oakland Regional office on 3/7/24.

LPAs conducted interviews regarding the incident that occurred on 2/29/24, where staff was accused of tapping a child with a bamboo pointer stick to grab their attention while teaching the curriculum. The interviews indicated that the staff did tap the child's arm to get their attention and to remind them to pay attention to the curriculum.

See LIC809-D for one Type B deficiency.

Exit interview conducted.
A copy of the report and appeal rights provided to Licensee Ursula Sanders.
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: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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 03/14/2024 05:25 PM - It Cannot Be Edited


Created By: Indira Loza On 03/14/2024 at 04:28 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: SANDERS, URSULA
FACILITY NUMBER: 013415554

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
04/12/2024
Section Cited
CCR
102423(a)(1)

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Personal Rights - (a) Each child receiving services from a family child care home shall have certain rights that shall not be waived or abridged by the licensee regardless of consent or authorization from the child's authorized representative. These rights include, but are not limited to, the following:(1) To be treated with dignity in his/her personal
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The Licensee shall come up with a plan that describes alternative methods to getting a child's attention that does not involve tapping on the shoulder. This plan must be emailed to the LPA no later than April 14, 2024.
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relationship with staff and other persons. This requirement was not met as evidenced by: Based on child and staff interviews it was determined that staff used a stick to tap a child on the arm to get their attention which poses a potential health, safety, personal rights risk to 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: 03/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2024


LIC809 (FAS) - (06/04)
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