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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013420548
Report Date: 01/08/2025
Date Signed: 01/08/2025 01:25:27 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
10/17/2024 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20241017145914
FACILITY NAME:UCB - UNIVERSITY VILLAGE ECEPFACILITY NUMBER:
013420548
ADMINISTRATOR:LAUREANA MEDRANOFACILITY TYPE:
850
ADDRESS:1123 JACKSON STTELEPHONE:
(510) 642-1827
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY:50CENSUS: 19DATE:
01/08/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Shima (Narges) AskariTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Day care child wandered from the facility due to lack of staff supervision
INVESTIGATION FINDINGS:
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On January 8, 2024 at 9:30am Licensing Program Analyst (LPA) Indira Loza met with Director Shima (Narges) Askari to conclude the complaint investigation for the above allegation. Present during today's visit were 19 preschoolers and 8 staff. The facility was toured for a health and safety check.

During the course of the investigation, staff, children, and parent interviews were conducted, observations were conducted, and records were reviewed. Based on records reviewed and interviews, it was stated that staff saw the child walking in the classroom and the child was in the dramatic area (which is in the back of the class). However, the child was able to leave the classroom and go to the small alley behind the building. There were 4 children and 3 staff present when the incident occurred, meaning there was an enough staff present to prevent the incident from occurring. The preponderance of evidence standard has been met, therefore this allegation is SUBSTANTIATED, California Code of Regulations 101229(a)(1) is being cited.

See LIC9099-D for Type A citation.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
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 3
Control Number 02-CC-20241017145914
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 - UNIVERSITY VILLAGE ECEP
FACILITY NUMBER: 013420548
VISIT DATE: 01/08/2025
NARRATIVE
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LPA informed Director Askari that this report dated 1/8/25 documents one Type A citation, which shall be posted for 30 consecutive days, as there is an immediate risk to the safety of children in care. LPA also informed the Licensee to provide a copy of this licensing report, dated 01/08/2025 documenting one Type A citation, to parents/guardians of all children currently enrolled by the next business day, or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or another written statement, must be placed in the child's file for verification.

Exit Interview Conducted.
Report and Appeal Rights provided to Director Shima (Narges) Askari.
Report and Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20241017145914
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 - UNIVERSITY VILLAGE ECEP
FACILITY NUMBER: 013420548
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/09/2025
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision - (a) The licensee shall provide care and supervision as necessary to meet the children's needs (1)No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
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The Director shall email a plan detailing the changes they will make to prevent this type of incident from occuring again. This plan shall be emailed to the LPA no later than 1/9/25.
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This requirement was not met as evidenced by: Based on interviews and records reviewed it was determined that a child was able to leave the facility premises unsupervised which poses an immediate health, safety, and personal right risk to 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: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3