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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211909
Report Date: 08/17/2023
Date Signed: 08/17/2023 05:26:41 PM


Document Has Been Signed on 08/17/2023 05:26 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 PROGRAMFACILITY NUMBER:
010211909
ADMINISTRATOR:LEVYA-CUTLER,B.&CUEVA, M.FACILITY TYPE:
840
ADDRESS:1718 - 8TH STREETTELEPHONE:
(510) 524-7300
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:65CENSUS: 19DATE:
08/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:38 PM
MET WITH:Yanci LuceroTIME COMPLETED:
05:32 PM
NARRATIVE
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On August 17, 2023 at 3:38pm Licensing Program Analyst (LPA) Indira Loza met with Site Supervisor Yanci Lucero. Present for the inspection were 19 school-age children. LPA conducted a tour of the facility for a Health and Safety check.

Upon reviewing the facility information and conducting interviews, it was determined that the facility does not have a Director. There hasn't been a Director for the facility since December 31, 2022, which violates California Code of Regulation 101215.1(b).

See LIC 809-D for one Type B deficiency.

An exit interview was conducted with Site Supervisor Yanci Lucero.
Report and Appeal Rights provided.
Notice of Site Visit must remain posted for 30 days.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
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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Document Has Been Signed on 08/17/2023 05:26 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/01/2023
Section Cited
CCR
101215.1(b)

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Child Care Center Directors Qualifications and Duties - (b) All child care centers shall have a director.
This requirement was not met as evidenced by:
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There shall be a completed Director's packet for Y. Lucero submitted no later than September 1, 2023.
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Based on interview and record review it was determined that this facility has not had a Director since December 31, 2022. This poses a potential risk to the Health, Safety, or Personal Rights of the children in care.
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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 MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023
LIC809 (FAS) - (06/04)
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