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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010209466
Report Date: 12/17/2019
Date Signed: 12/17/2019 11:28:26 AM

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:ST. JOHN'S CENTER CHILD CARE PROGRAMFACILITY NUMBER:
010209466
ADMINISTRATOR:CELESTE LOWFACILITY TYPE:
830
ADDRESS:2717 GARBER STREETTELEPHONE:
(415) 549-9342
CITY:BERKELEYSTATE: CAZIP CODE:
94705
CAPACITY:10CENSUS: 6DATE:
12/17/2019
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Assistant Director Laurie RobinsonTIME COMPLETED:
11:45 AM
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On 12/17/2019 Licensing Program Analyst (LPA) Brittany Newton made an unannounced Case Management visit for the purpose of conducting an Annual Continuation inspection. LPA was met by Assistant Director Laurie Robinson. Later, Director Celeste Low joined the inspection. Present in the infant classroom was six infants with two teachers. The classroom was free of toxins and hazardous materials. Sign in/out sheet was reviewed and found to be accurate with the infants present today.

A file review was conducted for two teachers and two infants which were found to be in compliance. Both teachers in the classroom have current CPR and First Aid until March 2020. Mandated reporter training was also found on file and was current. Infant files had required forms including consent for Medical Treatment, immunization's, Needs and Services plan, and I.D emergency information.

No deficiencies cited at this visit. Appeal rights provided, exit interview conducted, and a copy of this report was left with Director Celeste Low.



SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019
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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