010200115-5-11-2023-02-CC-MMEA-CSKN4W-20230607100838

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 010200115
Report Date: 05/11/2023
Date Signed: 05/11/2023 12:24:46 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
03/24/2023 and conducted by Evaluator Indira Loza

COMPLAINT CONTROL NUMBER: 02-CC-20230324151155

FACILITY NAME:	CHILDRENS COMMUNITY CENTER		FACILITY NUMBER:	010200115
ADMINISTRATOR:	KATHY CHEW		FACILITY TYPE:	850
ADDRESS:	1140 WALNUT ST		TELEPHONE:	(510) 528-6975
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94707
CAPACITY:	52	CENSUS: 42	DATE:	05/11/2023
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Lara Gabato		TIME COMPLETED:	12:29 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights - Day care children are being injured by other children while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On May 11, 2023 at 9:13am, Licensing Program Analyst (LPA) Indira Loza and Licensing Program Manager (LPM) Mayla Mendoza conducted an unannounced visit to investigate the above allegation. LPA and LPM toured the facility for a health and safety check. Present in care were 42 children, 7 fingerprint cleared staff, and 11 parents.

During the visit LPA and LPM conducted children interviews and toured the facility. Based on the children, staff, and parent interviews conducted, it has been determined that a child caused injury to another child. Therefore, this allegation has been Substantiated.

See LIC809-D for Type B Deficiency.

Exit Interview conducted.
Report and appeal rights provided with Lara Gabato.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

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

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
03/24/2023 and conducted by Evaluator Indira Loza

COMPLAINT CONTROL NUMBER: 02-CC-20230324151155

FACILITY NAME:	CHILDRENS COMMUNITY CENTER		FACILITY NUMBER:	010200115
ADMINISTRATOR:	KATHY CHEW		FACILITY TYPE:	850
ADDRESS:	1140 WALNUT ST		TELEPHONE:	(510) 528-6975
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94707
CAPACITY:	52	CENSUS: 42	DATE:	05/11/2023
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Lara Gabato		TIME COMPLETED:	12:29 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of Supervision - Day care children are not being adequately supervised.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On May 11, 2023 at 9:13am, Licensing Program Analyst (LPA) Indira Loza and Licensing Program Manager (LPM) Mayla Mendoza conducted an unannounced visit to investigate the above allegation. LPA toured the facility for a health and safety check. Present in care were 42 children, 7 fingerprint cleared staff, and 11 parents.

During the visit LPA and LPM conducted children interviews and toured the facility. Parent, staff, and children interviews were conducted during the course of the investigation. Despite the fact that most stated there was adequate supervision, there were an couple of interviews which indicated that there were no adults present, therefore this allegation has been concluded as Unsubstantiated. Although the allegation may have happened or be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Exit Interview conducted. Report and appeal rights provided with Lara Gabato.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 02-CC-20230324151155

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: CHILDRENS COMMUNITY CENTER	FACILITY NUMBER: 010200115
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/11/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/01/2023 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	Personal Rights - (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:	1 2 3 4 5 6 7	Director will come up with a plan to ensure the safety of the children in care. The plan must be emailed to LPA Loza no later than June 1, 2023.
	8 9 10 11 12 13 14	Based on parent, staff, and children interviews it has been determined that there child caused injury to another child	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3