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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013422499
Report Date: 11/12/2021
Date Signed: 11/12/2021 03:50:01 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
08/17/2021 and conducted by Evaluator Catherine Fernandes
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20210817110654
FACILITY NAME:EAST BAY GERMAN INTERNATIONAL SCHOOLFACILITY NUMBER:
013422499
ADMINISTRATOR:KACHINE BLACKWELLFACILITY TYPE:
850
ADDRESS:1070 41ST STREETTELEPHONE:
(510) 679-2199
CITY:EMERYVILLESTATE: CAZIP CODE:
94608
CAPACITY:59CENSUS: 32DATE:
11/12/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rufus PichlerTIME COMPLETED:
03:58 PM
ALLEGATION(S):
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Facility is operating out of ratio.
A complete and current record for each child is not maintained in the child care center.
INVESTIGATION FINDINGS:
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On November 12, 2021 at 2:31PM, Licensing Program Analyst (LPA) Catherine Fernandes conducted announced visit to deliver the findings to the above complaint allegations. During the course of the investigation LPA Fernandes conducted interviews and reviewed center documents pertaining to the complaint.

LPA Fernandes was given a class roster, a list of all the teachers along with transcripts and according to the documents Preschool classroom 3 does not have a qualified teacher. On 9/15/21, Licensing Program Manager Mayla Mendoza conducted an annual inspections and while reviewing center files four out of 10 children's files were incomplete. Then on another incident dated 10/22/21 LPA Fernandes reviewed a random sampling of 5 children's files and of the five, three were incomplete.
Therefore the above allegations are SUBSTANTIATED, the preponderance of evidence standard has been met. Title 22, is being cited on the attached LIC. 9099D.

An exit interview was conducted
Report and Appeal Rights provided
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: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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 3
Control Number 02-CC-20210817110654
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: EAST BAY GERMAN INTERNATIONAL SCHOOL
FACILITY NUMBER: 013422499
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2021
Section Cited
CCR
101216.1(b)(1)
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Teacher Qualifications and Duties A teacher shall have completed, with passing grades, at least six postsecondary semester or equivalent quarter units of the education requirement specified in (c)(1)... This requirement has not been met as evidenced by.
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Center will review teacher quailifacations and reassign teachers so each classroom will have a qualified teacher. Then send a copy of the teacher schedule to ensure ratios.
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Based on records review one of the three classrooms does not have a qualified teacher, which could be a potential risk to children in care.
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Type B
11/26/2021
Section Cited
CCR
101221(a)
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Child's Records A separate, complete and current record for each child is maintained in the child care center. This requirement has not been met as evidenced by:
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Center shall come up with a checklist to ensure all required documents are in the center files. Then send a copy of the list to CCLD.
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Based on two separate inspections the children's files were incomplete, which is a potential 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: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3