010211909-4-21-2023-02-CC-ILOA-CR4R6F-20230421124441

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010211909
Report Date: 04/20/2023
Date Signed: 04/21/2023 12:51:04 PM

Document Has Been Signed on 04/21/2023 12:51 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:	BAHIA SCHOOL AGE PROGRAM		FACILITY NUMBER:	010211909
ADMINISTRATOR:	LEVYA-CUTLER,B.&CUEVA, M.		FACILITY TYPE:	840
ADDRESS:	1718 - 8TH STREET		TELEPHONE:	(510) 524-7300
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94710
CAPACITY:	65	CENSUS: 16	DATE:	04/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:23 AM
MET WITH:	Yancy Lucero-Rivera		TIME COMPLETED:	03:10 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 April 20, 2023 at 10:23am, Licensing Program Analyst (LPA) Indira Loza conducted an unannounced Annual Inspection. LPA met with facility representative Yanci Lucero-Rivera and explained the purpose of today's inspection. There were 16 children and five staff. All adults in the facility have a criminal background clearance. The facility was toured for a health and safety inspection. The operating days and hours are Monday - Friday from 1pm - 6pm and 7:30am - 6pm when school is out for vacation. Indoor space: Facility operates out of three classrooms, and a multipurpose room. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Trash cans for solid waste had tight-fitting covers on and were in good repair. LPA observed a 3A40BC fire extinguisher, a working Smoke detector and working Carbon Monoxide Detectors. The last Fire Drill was conducted on Januray 19, 2023. Facility does not provide transportation. Facility’s License, Parents’ Rights Poster, Personal Rights, Activity Schedules, and menus were observed to be posted. Outdoor Space: Outdoor playground was inspected and observed to be fully fenced and safe. LPA observed play area for children. The play equipment was maintained in good condition and free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs falls. LPA Observed plenty of shade for the children in care. There were no bodies of water observed. The staff accompany the children to the park adjacent to the facility. LPA observed water fountains used to refill the children's water bottles. File Review: Children sign in and out procedures and logs were reviewed. All files contained required documents. There was at least one staff with current certification in Pediatric CPR/First Aid present at the *********************Report Continues on LIC 809-C*********************

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: BAHIA SCHOOL AGE PROGRAM	FACILITY NUMBER: 010211909
	VISIT DATE: 04/20/2023

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
26
27
28
29
30
31
32

facility during today's inspection. Children's Roster and personnel report was reviewed, and a copy obtained. The facility is currently not providing any Incidental Medical Services.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02. When any IMS is provided, an updated Plan of Operation that includes IMS must be 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

Director is reminded that any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years at Mandatedreporterca.com. California Law requires Child Care Centers 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, fax, or e-mail. The Children's Roster must be properly maintained, and fire/disaster drill every six months must be documented.

Staff was 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.
To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/ction-process.

There were no deficiencies cited during today's visit.

Exit interview conducted with Director Yanci Lucero-Rivera. Report and Appeal Rights Provided.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira Loza	TELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2