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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423679
Report Date: 05/17/2023
Date Signed: 05/17/2023 11:52:57 AM


Document Has Been Signed on 05/17/2023 11:52 AM - 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:SANTANA, GERALDOFACILITY NUMBER:
013423679
ADMINISTRATOR:SANTANA, GERALDOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 527-1652
CITY:BERKELEYSTATE: CAZIP CODE:
94702
CAPACITY:14CENSUS: 7DATE:
05/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:16 AM
MET WITH:Geraldo & Prisylle SantanaTIME COMPLETED:
11:58 AM
NARRATIVE
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On May 17, 2023 at 11:16am Licensing Program Analyst (LPA) Indira Loza met with Licensee Geraldo Santana. There were 5 infants, two preschool age children, and two fingerprint cleared staff present during today's visit.

Based on observation, record review, and interview it was determined that 5 of the 7 children were infants. This violates the California Code of Regulation 102416.5(d)(1), which is a Type A citation.

See 809-D for the Type A deficiency. A civil penalty was issued, due to this being a repeat violation within 12 months.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

Exit interview conducted. Report and appeal rights provided to Licensee Geraldo Santana.
Notice of Site visit must remain posted for 30 days.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023
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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Document Has Been Signed on 05/17/2023 11:52 AM - It Cannot Be Edited

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: SANTANA, GERALDO
FACILITY NUMBER: 013423679

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/18/2023
Section Cited
CCR
102416.5(d)(1)

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Staffing Ratio and Capacity (d) For a Large Family Child Care Home, the maximum number of children for whom care may be provided at any one time ... shall be either: (1) Twelve children, no more than four of whom may be infants. This requirement was not met as evidenced by:
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Licensee shall review the regulation, ensure that they have a maximum of four infants (under 24 months old) in care, LPA will make an additional visit within 10 days to verify compliance.
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Basedon interviews, record review, and observation, it has been determined that there were 5 infants in care during the visit which poses an immediate risk to the health and safety to the 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) 292-9724
LICENSING EVALUATOR NAME: Indira LozaTELEPHONE: 510-368-3672
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023
LIC809 (FAS) - (06/04)
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