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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013417502
Report Date: 01/26/2023
Date Signed: 01/26/2023 12:52:50 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/07/2022 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20221107143652
FACILITY NAME:AQUATIC PARK SCHOOLFACILITY NUMBER:
013417502
ADMINISTRATOR:BAUER, ANNFACILITY TYPE:
850
ADDRESS:830 HEINZ AVENUETELEPHONE:
(510) 843-2273
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:58CENSUS: 53DATE:
01/26/2023
UNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Ann BauerTIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Personal Rights - Staff did not adequately supervise child's behaviors to prevent incidents with other children being hurt
INVESTIGATION FINDINGS:
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On January 26, 2023 at 9:06am Licensing Program Analyst (LPA) Indira Loza and Licensing Program Manager (LPM) Mayla Mendoza met with Director Ann Bauer to conclude a complaint investigation. During the course of the investigation LPA Loza and LPM Mendoza conducted interviews and observed the children.

LPA and LPM conducted nterviews and observations determined that a child did have a tendency to express themselves through physical means. Although the staff attempted to mitigate the child's physical expressions, the child was still able to hurt other children, which violates the children's Personal Rights. Based on LPA and LPM interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Title 22, California Code of Regulations are being cited on the attached LIC 9099 D.

The facility will be sited a Type B violation based on this substantiated allegation.
Report and Appeal Rights provided to Director Ann Bauer. Notice of Site Visit must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 02-CC-20221107143652
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: AQUATIC PARK SCHOOL
FACILITY NUMBER: 013417502
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2023
Section Cited
CCR
101223(a)(2)
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(a) The licensee shall ensure that each child is accorded the following personal rights:...(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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Director shall come up with a plan to ensure the safety of all children in the facility. (e.g. one-on-one staff)

On October 14, 2022 the Director implemented a designated staff to shadow the child throughout the day.
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Based on interviews, it was revealed that a child was able to cause harm to other children which poses a potential risk to the health and safety of 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.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2