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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420567
Report Date: 11/08/2024
Date Signed: 11/08/2024 03:14:44 PM

Document Has Been Signed on 11/08/2024 03:14 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
OAKLAND CC RO, 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: 6DATE:
11/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Elizabeth MurrayTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 11/8/24 at 1:00 PM Licensing Program Analysts (LPAs) J. Vargas and D. Campos conducted an unannounced case management-deficiencies visit as a result of a complaint investigation inspection in the infant program. LPAs met with the center director Elizabeth Murray. Present during the visit were 4 staffs and 6 preschoolers in care.

During the investigation, LPAs observed pest control arrive to treat the ant infestation in the affected preschool classrooms. LPAs toured the classroom and observed ants on the classroom ramp. Director stated facility has been continuously treating the ant infestation as needed and has submitted copies of the pest control and deep cleaning work orders.

See LIC 809-D for deficiency cited today.

Notice of site visit was provided and must be posted for 30 days.
Exit interview and report reviewed with the director Elizabeth Murray.
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Joe Mary Vargas
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 11/08/2024 03:14 PM - It Cannot Be Edited


Created By: Joe Mary Vargas On 11/08/2024 at 02:01 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: 11/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2024
Section Cited
CCR
101238(a)(1)

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Buildings and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. The licensee shall take measures to keep the center free of flies, other insects, and rodents.
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Director stated that facility reached out to pest control twice and conducted a deep cleaning of the classrooms affected. Director provided copies of the third party work orders. Deficieny has been cleared today.
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This requirement was not met as evidenced by: per interviews, staff admitted to ant infestation on at least two occasions inside the preschool classrooms.
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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:Monica Mathur
LICENSING EVALUATOR NAME:Joe Mary Vargas
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2024


LIC809 (FAS) - (06/04)
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