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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420567
Report Date: 07/09/2024
Date Signed: 07/09/2024 05:01:17 PM

Document Has Been Signed on 07/09/2024 05:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CENTERFACILITY NUMBER:
013420567
ADMINISTRATOR/
DIRECTOR:		WOO, LANIFACILITY TYPE:
850
ADDRESS:6529 HOLLIS STREETTELEPHONE:
(510) 596-6699
CITY:EMERYVILLESTATE: CAZIP CODE:
94608
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 27DATE:
07/09/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:04 PM
MET WITH:Elizabeth MurrayTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
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On July 9, 2024 at 9:10am Licensing Program Analyst (LPA) Indira Loza arrived at the facility to complete the complaint investigation for the above allegation. Present during today's visit were 27 preschool age children, and 5 fingerprint cleared staff. LPA conducted a tour of the facility for a Health and Safety check.

At approximately 3:45pm LPA saw an infant being brought into the Mt. Rainier- Two's class. LPA asked why the child was in a preschool class, and was informed that the child was in the preschool class because the infant component was going to be out of ratio. This is a Type A violation.

LPA also noticed that the Parent Board did not have the report and Notice of Site Visit dated 6/26/24. The report had a Type A violation, meaning it was supposed to be posted on the parent's board along with the Notice of Site Visit next to it. Failure to meet the posting requirements is a Type B citation, and also carries a civil penalty of $100 per day the regulation is violated. There will be a $100 civil penalty issued during visit.

LPA informed Acting Director Murray that this report dated 07/09/24 documents one Type A citation, which shall be posted for 30 consecutive days, as there is an immediate risk to the safety of children in care. LPA also informed the Licensee to provide a copy of this licensing report, dated 07/09/24 documenting a 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. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or another written statement, must be placed in the child's file for verification.

Exit Interview Conducted.
Report and Appeal Rights provides.
Reviewed with Acting Director Elizabeth Murray.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2024 05:01 PM - It Cannot Be Edited


Created By: Indira Loza On 07/09/2024 at 04:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CCLC - CLIF BASE CAMP CHILD CARE CENTER
FACILITY NUMBER: 013420567

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/10/2024
Section Cited
CCR
101161(a)

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(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 is not met as evidenced by:
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The Acting Director shall create a plan describing how they will avoid using commingling to manage any ratio issues. This plan must be emailed to the LPA no later than the close of business on 7/10/2024
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Based on observation and interview it was determined that a 19 month old infant was placed in a preschool classroom to avoid being out of ratio in the infant class, which poses an immediate risk to the health, safety, and personal rights of 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 Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/09/2024 05:01 PM - It Cannot Be Edited


Created By: Indira Loza On 07/09/2024 at 04:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CCLC - CLIF BASE CAMP CHILD CARE CENTER
FACILITY NUMBER: 013420567

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/10/2024
Section Cited
CCR
1596.8596(a)(1)(c)

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(a)(1) facility shall post a copy of any licensing report pertaining to the facility that documents... a citation for a violation that, if not corrected, will create a direct and immediate risk to the health, safety, or personal rights of children in care. The licensing report provided by the department shall be posted immediately upon receipt, ... on, or immediately adjacent to, the interior side of the main door to the facility and shall remain posted for 30 consecutive days. (c) (3) This requirement is not met as evidenced by:
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The Acting Director shall send the LPA a picture of the report dated 6/26/24, the report dated 7/9/24, and the notice of Site Visit for 7/9/2024, posted on the parent board. This picture must be sent by close of business 7/10/2024
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Based on observation it was determined that the acting director did not post the report dated 6/26/24 and the Notice of Site Visit, on the parent board. This poses a potential risk to the health, safety, and personal rights of 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 Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 07/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/09/2024


LIC809 (FAS) - (06/04)
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