013423119-2-28-2023-02-CC-ILOA-CPH2RJ-20230228163738

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423119
Report Date: 02/28/2023
Date Signed: 02/28/2023 04:37:51 PM

Document Has Been Signed on 02/28/2023 04:37 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:	SHU REN INTERNATIONAL SCHOOL		FACILITY NUMBER:	013423119
ADMINISTRATOR:	CHEN, CHIEN-HSUAN		FACILITY TYPE:	850
ADDRESS:	2125 JEFFERSON AVENUE		TELEPHONE:	(510) 841-8899
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94703
CAPACITY: 104	TOTAL ENROLLED CHILDREN: 82	CENSUS: 75	DATE:	02/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:06 PM
MET WITH:	Chen Chien-Hsuan		TIME COMPLETED:	04:42 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On February 28, 2023 at 12:06pm, Licensing Program Analyst (LPA) Indira Loza met with Director Chen Chien-Hsuan for an Unannounced Required Annual Inspection. There were 75 preschool age children present. The teacher/ child ratio was being met today. The center was toured for a health and safety inspection. The facility operates from 7:00am – 6:00pm Monday through Friday. The preschool operates out of five classrooms within an elementary school. All sinks and toilets are observed to be clean and in proper working order. The facility has age appropriate materials in all classrooms that are observed to be clean and in good condition. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. Children have individual water bottles for drinking water. LPA observed a working carbon monoxide detector and a fully charged fire extinguisher. The fire system is hard wired. The outdoor play area is clean with ample age appropriate materials for the children. There is a play structure that is anchored into the ground. LPA did not observe any harmful or unattended bodies of water in or around the facility. The isolation area is in the Director's office. The facility is operating within its licensed capacity and is in ratio. All proper postings are made visible. The school does not provide any meals to the children. In the event a child forgets a meal, or does not have enough food, the facility will provide a small snack and inform the parent/guardian right away. The fire/disaster drill log was complete with the last drill conducted on January 18, 2023. A physical census of the children and staff were taken and cross referenced with the electronic sign-in and out log. All children were accounted for and properly signed in. All staff have obtained a criminal record clearance. Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to the child's parents, and to the Department of Social Services ****************************************Report Continues on 809-C****************************************

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SHU REN INTERNATIONAL SCHOOL	FACILITY NUMBER: 013423119
	VISIT DATE: 02/28/2023

NARRATIVE

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using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

This facility provides Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

There were no deficiencies cited during today's visit.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Director Chen Chien-Hsuan
Report and appeal rights provided.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2023

LIC809 (FAS) - (06/04)

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