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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 013423102
Report Date: 04/06/2021
Date Signed: 04/06/2021 02:12:32 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
03/30/2021 and conducted by Evaluator Brittany Newton
COMPLAINT CONTROL NUMBER: 02-CC-20210330091231
FACILITY NAME:GOLDEN GATE LEARNING CENTERFACILITY NUMBER:
013423102
ADMINISTRATOR:TABIQUE, MELISSAFACILITY TYPE:
830
ADDRESS:1450 SIXTH STREETTELEPHONE:
(510) 525-4841
CITY:BERKELEYSTATE: CAZIP CODE:
94710
CAPACITY:8CENSUS: 3DATE:
04/06/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Melissa TabiqueTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility is commingling children.
INVESTIGATION FINDINGS:
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On 04/06/2021, Licensing Program Analyst (LPA) Brittany Newton conducted an unannounced visit for the purpose of opening a complaint investigation. LPA was met by director Melissa Tabique. Present for the inspection was 3 infants.

Over the course of the investigation LPA interviewed staff and reviewed documentation. Interviews conducted revealed commingling of the children (mixing age groups) has been happening due to low staff numbers, and/or during pick up time. Therefore, the allegation is SUBSTANTIATED meaning LPA obtained during the investigation, the allegation is SUBSTANTIATED. A finding of "substantiated" means that the preponderance of evidence standard has been met.
Plan of Correction:
LPA issued a deficiency and a Plan of Correction (POC) with a due date, in order for the facility to correct the issue. See LIC 9099 D for deficiency. Facility shall also do the following:
Facility has been issued a type A deficiency, (serious violation). Parents and or responsible parties shall be provided a copy of this report including the LIC 9099, LIC 9099C and LIC 9099D.
Each parents/responsible party shall receive and sign off on the Acknowledgement of Receipt of Licensing Report form (LIC 9224) and a copy shall be placed in each child's file.
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: 04/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2021
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-20210330091231
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: GOLDEN GATE LEARNING CENTER
FACILITY NUMBER: 013423102
VISIT DATE: 04/06/2021
NARRATIVE
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Failure to complete POC by POC due date may result in Civil Penalties of up to $100 per day, per violation.

LPA issued a Notice of Site Visit to signor below. Notice of Site Visit must be posted in a prominent location in facility, for 30 days, visible to parents and visitors of the facility.

Appeal rights provided to facility and exit interview conducted.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Brittany NewtonTELEPHONE: (510) 622-2594
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20210330091231
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: GOLDEN GATE LEARNING CENTER
FACILITY NUMBER: 013423102
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/07/2021
Section Cited
CCR
101161
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101161(a) Limitations on Capacity and Ambulatory Status. (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement was not met as evidenced by:
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Facility will complete a written document stating they will cease commingling of children immediately. All staff should sign including Director and the Owner of facility. Facility shall email LPA Newton with document and signatures by 04/07/2021.
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Based on inteviews conducted, the toddlers, preschoolers, and infants have been mixed together at times which poses an immediate 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: 04/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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