013423120-4-24-2024-02-CC-ILOA-D4MS5V-20240424133457

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423120
Report Date: 04/24/2024
Date Signed: 04/24/2024 01:35:10 PM

Document Has Been Signed on 04/24/2024 01:35 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:	DOLMA CHILD CARE CENTER		FACILITY NUMBER:	013423120
ADMINISTRATOR/ DIRECTOR:	PALDON, TENZIN		FACILITY TYPE:	830
ADDRESS:	1700 - 7TH STREET		TELEPHONE:	(510) 414-8447
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94710
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 6	CENSUS: 5	DATE:	04/24/2024
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:00 AM
MET WITH:	Gerelbat Zoright		TIME VISIT/ INSPECTION COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On April 24, 2023 at 9:00am, Licensing Program Analyst (LPA) Indira Loza met with Directer Gerelbat Zoright to conduct an Unannounced Annual Continuation inspection. Present during today's visit were five (5) infants and two (2) fingerprint cleared staff. The facility was toured for a health and safety check. This facility holds a license for a preschool component #013423125. The hours of operation are 8am-10pm Monday through Sunday. CLASSROOMS: The infant component operates out of one classroom which was inspected. There were play and learning materials available for the children. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The center has a working combined smoke and carbon monoxide detector, working telephone, and pull down fire alarm system. FOOD SERVICE AREAS: The facility provides two snacks and the children bring lunch from home. The food preparation area is a kitchenette with no stove; and was observed be clean, well maintained, free from defects and hazards. All drawers and the refrigerator were all secured with child safety locks. OUTDOOR PLAY AREAS: There were plenty of age appropriate activities and plenty of shade for the children in care. The small climbing dome has cushioning underneath to absorb any falls. The outdoor play area is fully fenced in. There were no bodies of water or pools on the daycare premises. BATHROOMS AND TOILETING AREAS: The changing table has a padded surface covered with vinyl and is within arms reach of the sink. The sinks and faucets are in safe and sanitary operating condition. RECORDS: LPA reviewed 6 infant files which were all missing a sleep log, besides the missing sleep logs, the files were complete. Two staff files were also reviewed and were complete. All individuals subject to criminal record review have a criminal record clearance. Mandated Reporter Training was current for staff. The Director has a current CPR training certificate which expires on 12/5/24. All required documents are ************************** Page 1 of 3 *************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

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 04/24/2024 01:35 PM - It Cannot Be Edited

Created By: Indira Loza On 04/24/2024 at 10:18 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: DOLMA CHILD CARE CENTER	FACILITY NUMBER: 013423120
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(B)

Responsibility for Providing Care and Supervision for Infants

(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 6 out of 6 infants did not have an Infant Sleep Log on the initial visit on March 6, 2024 which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/24/2024
	Plan of Correction
1 2 3 4	The Licensee shall maintain the infant sleep logs daily by checking the napping infants every 15 minutes and documenting any: (1) Labored breathing. (2) Signs of distress, which includes but is not limited to flushed skin color, increase in body temperature and restlessness or if the child was normal. The Licensee shall provide 5 consecutive days of sleep logs and proof to LPA no later than May 24, 2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 04/24/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

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: DOLMA CHILD CARE CENTER	FACILITY NUMBER: 013423120
	VISIT DATE: 04/24/2024

NARRATIVE

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posted in a public accessible area. The last fire drill was conducted on 3/7/24. LPA observed a fully charged 2A10 fire extinguisher.

Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone or fax. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Director 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.

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 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. CCC completed testing and no exceedances. LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

This facility currently does not provide Incidental Medical Services – IMS. 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.
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SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: DOLMA CHILD CARE CENTER	FACILITY NUMBER: 013423120
	VISIT DATE: 04/24/2024

NARRATIVE

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Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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.

Director 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.

There was one citation issued during this inspection. See LIC809-D for the Type B deficiency.

Exit interview conducted.
Report was reviewed with the Director Tenzin Paldon who gave her husband Gerelbat Zoright permission to sign the report.
********************* End of Report ************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

LIC809 (FAS) - (06/04)

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