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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418996
Report Date: 12/29/2023
Date Signed: 12/29/2023 12:20:16 PM

Document Has Been Signed on 12/29/2023 12:20 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:CONGREGATION NETIVOT SHALOMFACILITY NUMBER:
013418996
ADMINISTRATOR:KAREN LLAMASFACILITY TYPE:
850
ADDRESS:1316 UNIVERSITY AVE.TELEPHONE:
(510) 549-9447
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY: 30TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/29/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Vanessa KimballTIME COMPLETED:
12:30 PM
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On 12/29/23 at 08:45 AM Licensing Program Analyst (LPA) Diana Campos conducted an unannounced Annual Required Inspection at Congregation Netivot Shalom. LPA met with Teacher, Vanessa Kimball and explained the purpose of today's inspection. LPA was granted inspection authority to enter the facility. The facility was toured to conduct a Health and Safety Inspection. Facility's operating days and hours are Monday-Thursday 8:00 AM-5:30 PM, Friday 8:00 AM -4:30 PM.

The physical plant was inspected. LPA toured the premises with Teacher.
Indoor space: Facility operates in 1 room: 3 teachers with 14 children. No children were present during today's inspection due to winter break.

The classrooms, restrooms, and spaces accessible to children were inspected. Disinfectants, cleaning solutions, poisons and other items that are dangerous to the health and safety of children in care were stored in places inaccessible to them during today's inspection. Storage areas for poisons were locked and medications were kept in a safe place inaccessible to day care children. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed, all toilets, and hand washing sink are observed to be in safe and sanitary operating condition. All floors were clean and safe. LPA observed Fire extinguisher, Smoke and Carbon Monoxide Detectors. All materials and surfaces accessible to children appeared to be toxic free. The center does not provide meals or snacks for children, instead all children bring their own meals and snacks from home.

Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards during today's inspection. Surface of the outdoor activity space was observed to be in safe condition and free of hazards during today's inspection. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. Facility was reminded to redistribute the material around and under high climbing equipment and slides enough to absorb a fall. There were no bodies of water observed. Drinking water is readily available to children during indoor and outdoor activities via personal water bottles. File Review: Children sign in/out procedures and logs were reviewed. All children were signed in by their authorized representative with full legal signatures. A sample of five (5) Children's files and five (3) Staff files were taken for review.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/29/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: CONGREGATION NETIVOT SHALOM
FACILITY NUMBER: 013418996
VISIT DATE: 12/29/2023
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Facility was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. PIN 22-05-CCP

LPA discussed the safe sleep regulations with Teacher Vanessa Kimball and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. And discussed the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

Facility was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

No deficiencies cited during today's inspection

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Teacher Vanessa Kimball.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2023
LIC809 (FAS) - (06/04)
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