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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419436
Report Date: 06/04/2024
Date Signed: 06/07/2024 06:50:08 AM

Document Has Been Signed on 06/07/2024 06:50 AM - 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:BUSD - FRANKLIN PRESCHOOLFACILITY NUMBER:
013419436
ADMINISTRATOR/
DIRECTOR:		CARRIEDO, MARIAFACILITY TYPE:
850
ADDRESS:1460 - 8TH STREETTELEPHONE:
(510) 644-4533
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 192TOTAL ENROLLED CHILDREN: 192CENSUS: 75DATE:
06/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Madeleine RoginTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On June 4, 2024 at 9:30am, Licensing Program Analyst (LPA) Indira Loza met with Principal Madeleine Rogin. The purpose of the visit was due to a self reported incident that was received in the Oakland Regional office on 5/28/24.

During today's visit LPA conducted children and staff interviews regarding the incident that occurred on 5/23/24, where a staff person was accused of twisting and pulling two children's ears. The children stated that their ears were pulled and twisted by the same person which violates the California Code of Regulations 101223(a)(3); resulting in a Type A deficiency which poses an immediate risk to the health, safety, and personal rights of children in care.

The Director must provide a copy of this report to all parents of children currently enrolled by June 5, 2024 by the close of business or the next day the child is in the facility. The Director must also provide the report to parents of newly enrolled children in the next 12 months. In addition, the "Acknowledgment of Receipt of Licensing Reports" (LIC 9224) must be signed by each parent and placed in each child's file.

A copy of the LIC 9224 is being provided to the Licensee during the inspection.


Exit interview conducted.
A copy of the report and appeal rights provided to Principal Madeleine Rogin.
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: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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 06/07/2024 06:50 AM - It Cannot Be Edited


Created By: Indira Loza On 06/04/2024 at 12:08 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: BUSD - FRANKLIN PRESCHOOL
FACILITY NUMBER: 013419436

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
06/05/2024
Section Cited
CCR
101223(a)(3)

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Personal Rights - (a) The licensee shall ensure that each child is accorded the following personal rights: 3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature... This
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The Director shall create a plan to prevent a similar incident from occuring again, this plan shall be emailed to the LPA no later than 6/5/24. There shall also be an all staff meeting dicussing the new plan and the Director shall send the LPA a copy of the sign in sheet no later than July 2. 2024.
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requirement was not met as evidenced by: Based on children interviews it was determined that a staff twisted and pulled two childrens' ears which poses an immediate risk to the health, safety, and personal rights of 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: 06/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/04/2024


LIC809 (FAS) - (06/04)
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