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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421994
Report Date: 11/16/2021
Date Signed: 11/16/2021 12:44:09 PM

Document Has Been Signed on 11/16/2021 12:44 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:BABY ACADEMY, THEFACILITY NUMBER:
013421994
ADMINISTRATOR:LOVE, YOLANDAFACILITY TYPE:
830
ADDRESS:1015 CAMBELL STTELEPHONE:
(510) 305-4877
CITY:OAKLANDSTATE: CAZIP CODE:
94607
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
11/16/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Porshia LewisTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Melissa Domantay and Licensing Program Manager (LPM) Mayla Mendoza met with Director Poshia Lewis for a case management inspection. Present for the inspection was 1 teachers aide supervising 2 infants.

The attached type B deficiency is cited today and must be corrected by the due date. This report must be available for public review for 3 years.
An exit interview was conducted and the report was discussed. Director Poshia Lewiswas provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.

A site visit notice was provided to the Poshia Lewis.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 11/16/2021 12:44 PM - It Cannot Be Edited


Created By: Melissa Domantay On 11/16/2021 at 12:21 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: BABY ACADEMY, THE
FACILITY NUMBER: 013421994

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2021
Section Cited
CCR
101416.5

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Staff-Infant Ratio
(b) There shall be a ratio of one teacher for every four infants in attendance.

This requirement was not met as evidenced by document review and licensee interview. There is no documentation that individual in the classroom is a qualified teacher. This poses an potential health and safety risk to children in care.
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Licensee will provide documentation that proves staff member is a fully qualified teacher or must meet appropriate staff-infant ratio by due date 11/17/21.

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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:Melissa Domantay
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2021


LIC809 (FAS) - (06/04)
Page: 2 of 2

Created By: Melissa Domantay On 11/16/2021 at 11:47 AM
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: BABY ACADEMY, THE
FACILITY NUMBER: 013421994

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2021
Section Cited
CCR
101416.5

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(b) There shall be a ratio of one teacher for every four infants in attendance.
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Licensee will provide documentation that proves both staff members are fully qualified teachers.

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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:Melissa Domantay
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2021


LIC809 (FAS) - (06/04)
Page: 1 of 1