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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013418965
Report Date: 04/18/2023
Date Signed: 04/18/2023 06:21:58 PM

Unsubstantiated


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
03/23/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230323153447
FACILITY NAME:UCB - HASTE STREET CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013418965
ADMINISTRATOR:PRATIBHA CHAYAFACILITY TYPE:
850
ADDRESS:2339 HASTE STREETTELEPHONE:
(510) 642-6673
CITY:BERKELEYSTATE: CAZIP CODE:
94720
CAPACITY:74CENSUS: 29DATE:
04/18/2023
UNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Moises RomanTIME COMPLETED:
06:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights - Staff yell at day care children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On April 18, 2023 at 9:41am, Licensing Program Analyst (LPA) Indira Loza conducted an unannounced visit to investigate the above allegation. LPA toured the facility for a health and safety check. Present in care were 29 children and 6 fingerprint cleared staff.

LPA conducted staff, children, and parent interviews which revealed that although the staff do raise their voices, they do it when it is loud and to get the all the children's attention. No child stated they were being yelled at or were affected by the raised voices. Although the allegation may have happened or be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

Exit Interview conducted.
Report and appeal rights provided with Moises Roman.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
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 4
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
03/23/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230323153447

FACILITY NAME:UCB - HASTE STREET CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013418965
ADMINISTRATOR:PRATIBHA CHAYAFACILITY TYPE:
850
ADDRESS:2339 HASTE STREETTELEPHONE:
(510) 642-6673
CITY:BERKELEYSTATE: CAZIP CODE:
94720
CAPACITY:74CENSUS: 29DATE:
04/18/2023
UNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Moises RomanTIME COMPLETED:
06:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights - Staff speak inappropriately to day care children
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On April 18, 2023 at 9:41am, Licensing Program Analyst (LPA) Indira Loza conducted an unannounced visit to investigate the above allegation. LPA toured the facility for a health and safety check. Present in care were 29 children and 6 fingerprint cleared staff.

LPA conducted staff, children, and parent interviews which revealed that although the staff do not speak to the children in an inappropriate manner. Although the allegation may have happened or be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

Exit Interview conducted.
Report and appeal rights provided with Moises Roman.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4
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
03/23/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230323153447

FACILITY NAME:UCB - HASTE STREET CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013418965
ADMINISTRATOR:PRATIBHA CHAYAFACILITY TYPE:
850
ADDRESS:2339 HASTE STREETTELEPHONE:
(510) 642-6673
CITY:BERKELEYSTATE: CAZIP CODE:
94720
CAPACITY:74CENSUS: 29DATE:
04/18/2023
UNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Moises RomanTIME COMPLETED:
06:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights - Staff handle day care children in a rough manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On April 18, 2023 at 9:41am, Licensing Program Analyst (LPA) Indira Loza conducted an unannounced visit to investigate the above allegation. LPA toured the facility for a health and safety check. Present in care were 29 children and 6 fingerprint cleared staff.

During the investigation LPA interviewed staff, children, and parents which indicated staff picked up and held a child as well as held children's arm as the children was trying to break free. The preponderance of evidence standard has been met, therefore the above allegation is to be substantiated. This is a Type A violation of California Code Regulations (CCR) section 101223(a)(1).

Notice of Site Visit was provided and must be posted for 30 days.
Exit interview and report reviewed with Moises Roman.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 02-CC-20230323153447
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: UCB - HASTE STREET CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013418965
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/19/2023
Section Cited
CCR
101223(a)(1)
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2
3
4
5
6
7
Personal Rights - 101223(a)(1) - (a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:
1
2
3
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6
7
The Director shall email the LPA a plan detailing how they will ensure that the children's personal rights are not violated no later than April 19, 2023. The Director shall also conduct a staff meeting on Personal Rights and email a sign in sheet for the meeting by April 28, 2023.
8
9
10
11
12
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14
Based on interviews conducted, it was determined that the staff picked up a child and hold children's arms while they were trying to break free. This poses a potential health and safety risk to the children in care.
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9
10
11
12
13
14
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2
3
4
5
6
7
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2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 04/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4