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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013420568
Report Date: 08/23/2023
Date Signed: 08/23/2023 04:55:40 PM

Substantiated


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
08/02/2023 and conducted by Evaluator Catherine Fernandes
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230802104020
FACILITY NAME:CCLC - CLIF BASE CAMP CHILD CARE CENTERFACILITY NUMBER:
013420568
ADMINISTRATOR:WOO, LANIFACILITY TYPE:
830
ADDRESS:6529 HOLLIS STREETTELEPHONE:
(510) 596-6699
CITY:EMERYVILLESTATE: CAZIP CODE:
94608
CAPACITY:17CENSUS: 14DATE:
08/23/2023
UNANNOUNCEDTIME BEGAN:
02:37 PM
MET WITH:Elizabeth MurrayTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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uncleared staff worked with infants prior to clearance
INVESTIGATION FINDINGS:
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On 8/23/23, at 2:37PM, Licensing Program Analysts (LPAs) Catherine Fernandes and Randall Dunevant arrived unannounced on a complaint investigation and met with Director Elizabeth Murray. Present in care were 14 infants and five additional staff members. During the investigation LPAs conducted interviews, reviewed center documents and did a walk through of the center.
Based on center documentation staff member 4 (S4) started working at the center on 5/30/23, however S4 was not cleared until 6/27/23. Therefore, the allegation is SUBSTANTIATED, the preponderance of evidence standard has been met. Title 22, California Code of Regulations is being cited on the attached LIC 9099 D. LPA Fernandes informed the Director that this report dated 8/23/23 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the safety of children in care. Also, LPA Fernandes informed the Director to provide a copy of this licensing report dated 8/23/23 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. Report continues on 809C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 02-CC-20230802104020
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: CCLC - CLIF BASE CAMP CHILD CARE CENTER
FACILITY NUMBER: 013420568
VISIT DATE: 08/23/2023
NARRATIVE
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A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

See 809D for deficiency.

Exit interview conducted
Report, Appeal Rights and Notice of site visit provided.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 02-CC-20230802104020
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: CCLC - CLIF BASE CAMP CHILD CARE CENTER
FACILITY NUMBER: 013420568
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
08/24/2023
Section Cited
CCR
101170(e)(1)
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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department This requirement has not been
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Center will come up with an on boarding plan to ensure all staff members are fingerprint cleared prior to being the center.
During the visit the Director provided the plan. Citaion was cleared.
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met as evidenced by: Based on center documents staff member 4 was cleared prior to working in the center which is an immediate risk to children in care
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Civil penalty of $500 has been assessed.
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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: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4