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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422501
Report Date: 05/13/2024
Date Signed: 05/13/2024 11:28:48 AM

Document Has Been Signed on 05/13/2024 11:28 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:PIXAR CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013422501
ADMINISTRATOR/
DIRECTOR:		SUSAN STEVENSONFACILITY TYPE:
850
ADDRESS:2600 10TH STREETTELEPHONE:
(510) 665-3904
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 21DATE:
05/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Ebony BellTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
NARRATIVE
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On May 13, 2024 Licensing Program Analyst (LPA) Indira Loza met with Assistant Director Ebony Bell. Present during the visit were 6 staff and 21 preschool children. The purpose of the visit was due to a self reported incident that was received in the Oakland Regional office on 5/3/24.

LPA conducted interviews regarding the incident that occurred on 5/3/24, where a child got their arm stuck inside of a round fence post which is used to hold umbrellas. The facility called 911 to get the child's arm out, which was not injured.

See LIC809-D for one Type B deficiency.

Exit interview conducted.
A copy of the report and appeal rights provided to Assistant Director Ebony Bell..
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: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2024
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 05/13/2024 11:28 AM - It Cannot Be Edited


Created By: Indira Loza On 05/13/2024 at 10:55 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: PIXAR CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013422501

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/14/2024
Section Cited
CCR
101223(a)(2)

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(a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
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The Director shall send the LPA plan detailing how to prevent this from happeneing again. The plan must be received by the Close of Business on June 14, 2024.
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Based on record review and interview it was determined that a child had their arm stuck in a fence post and staff had to call 911 after attempting to get the arm out. This poses a potential 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: 05/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2024


LIC809 (FAS) - (06/04)
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