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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013422499
Report Date: 05/16/2022
Date Signed: 05/17/2022 02:09:04 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
04/22/2022 and conducted by Evaluator Indira Loza
COMPLAINT CONTROL NUMBER: 02-CC-20220422170733

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: DATE:
05/16/2022
UNANNOUNCEDTIME BEGAN:
10:38 AM
MET WITH:Claudia MuellerTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff does not have a fingerprint clearance
INVESTIGATION FINDINGS:
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On May 16, 2022 Licensing Program Analysts (LPAs) Indira Loza and Melissa Domantay met with Principal Claudia Mueller to deliver the findings to the above complaint allegations.There are 51 children in care upon arrival to the center. LPAs toured the facility, conducted interviews and staff file reviews.

Based on staff interviews The preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, 101170 is being cited on the attached LIC 9099 D.

The attached type A deficiency is being cited today and must be corrected by the due date.

Exit interview conducted
Appeal Rights and Report provided
Notice of site visit was given and must be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20220422170733
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: 05/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2022
Section Cited
CCR
101170(e)(1)
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(e) 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:
(1) Obtain a California clearance or a criminal record exemption as required by the Department
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Director will submit a statement saying they will not allow the individual into the Preschool classroom, or will get them fingerprinted if they will decide to have them in the Preschool shadowing or working with preschool children. Director will ensure that any individual coming into contact with children will have a Criminal
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This requirement was not met as evidenced by interviews with staff indicating a person by the name of Rebecca Hoyt was in the classroom shadowing a Preschool class. This poses an immediate health and safety risk to children in care.
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Background Clearance and be associated to the facility.
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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: 05/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3