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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418160
Report Date: 06/03/2022
Date Signed: 06/03/2022 03:33:27 PM

Document Has Been Signed on 06/03/2022 03:33 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:BETH EL NURSERY SCHOOLFACILITY NUMBER:
013418160
ADMINISTRATOR:GLADSTONE, JODIFACILITY TYPE:
850
ADDRESS:1301 OXFORD STREETTELEPHONE:
(510) 848-9428
CITY:BERKELEYSTATE: CAZIP CODE:
94709
CAPACITY: 74TOTAL ENROLLED CHILDREN: 74CENSUS: 34DATE:
06/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Jodi GladstoneTIME COMPLETED:
03:40 PM
NARRATIVE
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On June 3, 2022 Licensing Program Analysts (LPAs) Indira Loza and Cherie Acosta arrived at the facility to conduct a case management visit as a direct result from a self reported Unusual Incident where two children on a bicycle rode from the facility and to into the streets.

The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.



Exit interview conducted with Director Jodi Gladstone, and a copy of this report was provided. Appeal rights were provided.

A notice of site visit was left with Ms. Gladstone and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2022
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 06/03/2022 03:33 PM - It Cannot Be Edited


Created By: Indira Loza On 06/03/2022 at 03:02 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: BETH EL NURSERY SCHOOL
FACILITY NUMBER: 013418160

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/06/2022
Section Cited
CCR
101223(a)(2)

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Personal Rights. The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by the two children in care who exited the courtyard on a bike and into the oncoming traffic, which
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The facility shall immediately cease using the courtyard as an outdoor play area until the Department has approved the courtyard for use.
The Director shall submit a letter to CCL by June 6, 2022 acknowledging that the courtyard will not be used for outdoor play.
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poses an immediate risk to the health and safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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: 06/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2022


LIC809 (FAS) - (06/04)
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