013423125-12-29-2021-02-CC-MDOY-CA6QW5-20211229113122

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423125
Report Date: 12/29/2021
Date Signed: 12/29/2021 11:32:20 AM

Document Has Been Signed on 12/29/2021 11:32 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:	PALDON, TENZIN		FACILITY NUMBER:	013423125
ADMINISTRATOR:	ZORIGHT, GERELBAT		FACILITY TYPE:	850
ADDRESS:	1700 - 7TH STREET		TELEPHONE:	(510) 414-8447
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94710
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 8	CENSUS: 0	DATE:	12/29/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Tenzin Paldon		TIME COMPLETED:	11:55 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	Licensing Program Analysts (LPAs) Melissa Domantay and Melissa Guirit conducted a Prelicensing inspection today, December 29, 2021 for the initial application that was submitted by the applicant. LPAs met with applicant/owner, Tenzin Paldon and toured all areas of the facility for a health and safety inspection. The hours of operation are Monday through Friday from 8:00am to 6:00pm. The measurements are as follows: INDOORS: 656.6 square feet = 18 children OUTDOORS : 651.18 square feet = 8 children A fire clearance, with a total capacity of 8 preschoolers, ages 2 years to first grade entry was received from the Berkeley Fire Department. LPAs observed that the classrooms has sufficient lighting and appears to be clean and in good condition. LPAs observed an ample supply of age appropriate activities, equipment and furniture. The facility has 3 sinks and 1 toilet. The classroom has a fully charged 2A10BC fire extinguisher, working fire alarm and carbon monoxide detector, and first aid supplies. There is a working telephone at the center. LPAs did not observe any hazardous items that would be accessible to children. Facility will provide drinking water for children indoors and outdoors. Food will be provided by children's families. The staff break room will be used for ill children as the isolation area. LPAs observed the outdoor play area, they are fully fenced and have amply supply of age appropriate activities, equipment, and furniture. Applicant will provide photos of mats surrounding climbing dome structure as cushioning for children. LPAs observed ample amount of shade for children. See 809-C for continuance.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

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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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: PALDON, TENZIN	FACILITY NUMBER: 013423125
	VISIT DATE: 12/29/2021

NARRATIVE

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Applicant is reminded that if facility plans to provide Incidental Medical Services a plan should be provided. – IMS. A Plan of Operation that includes IMS has been submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Gerelbat Zorigh will be considered a fully-qualified preschool director once his required class is completed in March 2022. An exception has been approved by Licensing Program Manager (LPM) Mayla Mendoza for Director Gerelbat Zorigh. Gerelbat has completed 16 hours of health and safety training including pediatric CPR and First Aid and Lead Poisoning.

Mandated reporter, appeal rights, civil penalties, unusual incident reporting, fingerprint requirements, and COVID protocols were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and checking Provider Information Notices (PINs). The director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

A license for 8 preschool children will be effective today 12/29/21. An exit interview was conducted, and a copy of the report was provided to applicant/owner Tenzin Paldon.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2021

LIC809 (FAS) - (06/04)

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