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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420567
Report Date: 08/14/2024
Date Signed: 08/14/2024 05:38:28 PM

Document Has Been Signed on 08/14/2024 05:38 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: 30DATE:
08/14/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Elizabeth MurrayTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
NARRATIVE
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On August 14, 2024 at 9:15am Licensing Program Analyst (LPA) Indira Loza met with Interim Director Elizabeth Murray. There were 8 toddlers, 30 preschoolers, and 8 fingerprint cleared staff present during the visit. LPA toured the facility for a Health and Safety check.

During today's visit LPA reviewed the facility roster and verified with the Director that Jonathan Powell was working at the center. Jonathan Powell's fingerprints are still "In Process", meaning he does not have a fingerprint clearance. Interviews stated that Jonathan was working around the children since Thursday August 8th until Tuesday August 13th. California Code of Regulations Title 22 101170(e)(1) is being cited with one Type A citation.

See LIC809-D.

Exit Interview conducted.
Report and Appeal Rights provided to Director Elizabeth Murray.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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 08/14/2024 05:38 PM - It Cannot Be Edited


Created By: Indira Loza On 08/14/2024 at 04:31 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: 08/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/15/2024
Section Cited
CCR
101170(e)(1)

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Criminal Record Clearance - (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 This requirement was not met as evidenced by:
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The Interim Director shall email a plan on how they will ensure that everyone who works in the facility has a fingerprint clearance. This plan shall be emailed no later than August 15th, 2024. Additionally, the Interim Director shall not have Jonathan return to the facility without a fingerprint clearance.
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Based on record review and interviews conducted, it was determined that Jonathan Powell was working with the children for at 4 days without a fingerprint clearance 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: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


LIC809 (FAS) - (06/04)
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