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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010214881
Report Date: 08/16/2021
Date Signed: 08/16/2021 12:18:12 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2021 and conducted by Evaluator Brittany Newton
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20210811121658
FACILITY NAME:BUSD - HOPKINS STREETFACILITY NUMBER:
010214881
ADMINISTRATOR:ROBINSON, KIMBERLYFACILITY TYPE:
850
ADDRESS:1810 HOPKINS STREETTELEPHONE:
(510) 644-8939
CITY:BERKELEYSTATE: CAZIP CODE:
94707
CAPACITY:140CENSUS: 36DATE:
08/16/2021
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Kim RobinsonTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility does not have a staff member with a valid CPR/first aid certificate
INVESTIGATION FINDINGS:
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On 08/16/2021, Licensing Program Analyst (LPA) Brittany Newton conducted an unannounced visit for the purpose of opening a complaint investigation regarding the above allegation. LPA was met by assisant supervisor Kim Robinson. Present for the inspection was 36 preschoolers. LPA conducted walk throughs of each classroom.

LPA reviewed documentation. Documentation revealed that the cpr and first aid certificates retained for staff were completely online and not from an accredited (EMSA) approved source, therefore, the certificates are invalid. Based on the preponderance of evidence, the allegation is therefore SUBSTANTIATED. Please see attached LIC809-D for citation issued.
A deficiency was cited at this visit. Exit interview conducted, appeal rights provided, and a copy of this report was left with the facility.
Notice of site visit provided and facility reminded it must remain posted for 30 days.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 02-CC-20210811121658
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: BUSD - HOPKINS STREET
FACILITY NUMBER: 010214881
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/20/2021
Section Cited
HSC
1596.866(b)
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 Day care center directors shall ensure that at least one staff member who has a current course completion card in pediatric first aid and pediatric CPR issued by the American Red Cross, the American Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority and shall be on site at all times
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Facility agrees to provide proof of enrollment in EMSA approved CPR and First Aid class for staff to LPA Newton by 08/20/2021.
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when children are present at the facility..
This requirement was not met as evidenced by:
Based on documentation review, the certificates retained by staff were completed online and are not EMSA approved which poses a potential Health, Safety, or Personal Rights risk to 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) 873-6408
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2