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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212490
Report Date: 02/02/2023
Date Signed: 02/02/2023 05:12:56 PM


Document Has Been Signed on 02/02/2023 05:12 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:UCB - HAROLD E. JONES CHILD STUDY CTR/CHILDCAREFACILITY NUMBER:
010212490
ADMINISTRATOR:IRIS BRADFORDFACILITY TYPE:
850
ADDRESS:2425 ATHERTON STREETTELEPHONE:
(510) 643-5449
CITY:BERKELEYSTATE: CAZIP CODE:
94704
CAPACITY:56CENSUS: DATE:
02/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Sasha LevetonTIME COMPLETED:
05:20 PM
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On February 2, 2023 at 11:55am, Licensing Program Analyst (LPA) Indira Loza met with Interim Director Sasha Leveton for an Unannounced Required Annual Inspection. There were 27 preschool age children and 8 additional fingerprint cleared teachers. The center was toured for a health and safety inspection. The facility operates from 8:15am – 5:15pm Monday through Friday.

The preschool operates out of two classrooms with six toilets and six sinks. All sinks and toilets are observed to be clean and in proper working order. The facility has age appropriate materials in all classrooms that are observed to be clean and in good condition. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. Children have individual water bottles for drinking water. Each classroom has a fully charged fire extinguisher. The fire system is hard wired. The outdoor play area is clean with ample age appropriate materials for the children. The yard is fully fenced in and has plenty of shade for the children. LPA did not observe any harmful or unattended bodies of water in or around the facility. The isolation area will be in the first classroom next to the Director's desk.

The facility is operating within its licensed capacity and is in ratio. All proper postings are made visible. The school provides all meals or snacks for the children. The fire/disaster drill log was complete with the last fire drill logged January 25, 2023 and January 26, 2023 for the earthquake drill. A physical census of the children and staff were taken and cross referenced with the sign-in and out log in each classroom. All children were accounted for and properly signed in. LPA reviewed all of the current staff records and twelve children's files. All children files were complete and current.

Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six
************************************************Report Continues on 809-D***************************************
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
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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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: UCB - HAROLD E. JONES CHILD STUDY CTR/CHILDCARE
FACILITY NUMBER: 010212490
VISIT DATE: 02/02/2023
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(6) months and documented. Director was reminded that California Law requires all facilities 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 or fax. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication, equipment, and supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 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/process.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

See 809-D for the Type B deficiency.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Interim Director Sasha Leveton.
Report and appeal rights provided
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/02/2023 05:12 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: UCB - HAROLD E. JONES CHILD STUDY CTR/CHILDCARE

FACILITY NUMBER: 010212490

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 02/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(b)
Child Care Center Director Qualifications and Duties
(b) All child care centers shall have a director.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above as the listed Director responsible for the facility has not been present for ten months which poses a potential safety risk to persons in care.
POC Due Date: 02/28/2023
Plan of Correction
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Interim Director shall submit a complete Director packet by February 28, 2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 02/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
LIC809 (FAS) - (06/04)
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