010210187-9-27-2021-02-CC-BNEN-C79S6R-20210927133622

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010210187
Report Date: 09/27/2021
Date Signed: 09/27/2021 01:36:31 PM

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:	ALA COSTA CTR. FOR THE DEVELOPMENTALLY DISABLED		FACILITY NUMBER:	010210187
ADMINISTRATOR:	PEREIRA, MICHAEL A.		FACILITY TYPE:	840
ADDRESS:	1300 ROSE STREET		TELEPHONE:	(510) 527-2550
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY:	58	CENSUS: 0	DATE:	09/27/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Michael Pereira and Kelly Copeland		TIME COMPLETED:	02:00 PM

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 09/27/2021, Licensing Program Analyst (LPA) Brittany Newton conducted an unannounced visit for the purpose of conducting a required one year inspection. LPA was met by Executive Director Michael Pereira and Assistant Director Kelly Copeland. Present for the inspection was 0 children. LPA toured the facility with the staff. This program is an after school program. The facility currently operates in one classroom and the main hall. Age appropriate sensory toys and the environment is set up for the children the facility serves. Classroom areas were found free of hazards, poisons, and cleaning supplies. The facility has a fully stocked first aid kit. Staff tested the carbon monoxide and fire detector which were found operable. There is a fully charged 2A10BC fire extinguisher on site. Facility has not been conducting fire drills because it was closed for a year, facility recently reopened in July and is planning a fire drill this week. The facility provides snacks for children. A menu is posted. Drinking water is available. Bathroom areas were inspected and were found operable. Soap, paper towels, and a trash can with a tight fitting lid was observed. Required forms are posted. There are no bodies of water on site. Per the director, there are no firearms on site. All children files were reviewed and found complete. Staff files were reviewed and found complete. CPR and First Aid is current for at least one staff member on site, expiring 05/17/2023. LPA reminded facility to ensure that mandated reporter training is completed every 2 years for staff members. The facility uses the attached park for outdoor play.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Brittany Newton	TELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021

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: ALA COSTA CTR. FOR THE DEVELOPMENTALLY DISABLED	FACILITY NUMBER: 010210187
	VISIT DATE: 09/27/2021

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. This facility provides IMS and has a plan on file. 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.

Facility has implemented best practices during check in and check out process of children due to COVID-19. This includes hand sanitizing stations, required posted flyers limiting visitors and staff are wearing a mask while providing care.

Kelly will send child care roster to LPA Newton. A copy of the personnel roster was obtained.

Facility representatives were reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

No deficiencies cited at this visit. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, appeal rights provided, and this report was reviewed with the facility staff Michael Pereira and Kelly Copeland.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Brittany Newton	TELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021

LIC809 (FAS) - (06/04)

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