013423781-9-3-2024-02-CC-MDOY-D8RVBN-20240903161749

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423781
Report Date: 09/03/2024
Date Signed: 09/03/2024 04:18:44 PM

Document Has Been Signed on 09/03/2024 04:18 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:	UCB CLARK KERR CAMPUS CHILDREN CENTER		FACILITY NUMBER:	013423781
ADMINISTRATOR/ DIRECTOR:	BORIS ALVARADO		FACILITY TYPE:	860
ADDRESS:	2900 DWIGHT WAY BLDG 5		TELEPHONE:	(510) 642-0104
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94720
CAPACITY: 17	TOTAL ENROLLED CHILDREN: 17	CENSUS: 4	DATE:	09/03/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Moises Roman		TIME VISIT/ INSPECTION COMPLETED:	01:30 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 Tuesday, September 3, 2024 Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) M. Domantay met with Executive Director Moises Roman for the purpose of a Prelicensing inspection. Applicant requests to add a Toddler Program and requesting to remove the Preschool Program and change preschool classrooms to become the Toddler classrooms. Also on site, is an existing Infant Program. Facility is requesting to serve 17 Toddler children from ages 18 to 36 months with an Infant program serving 12 infants birth to 24 months. The program will operate Monday through Friday from 8:00am to 5:30pm. The fire clearance was granted and approved on 7/17/2024 from the UC Berkeley Fire Prevention. The facility does provide food and snacks for children. LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. LPA informed Moises that the facility will be converted to a single child care center license under facility number 013423781, therefore LPA will be closing the current preschool facility number 10216245 and infant facility number 13421386. INDOOR ACTIVITY SPACE: There are 2 Toddler indoor areas: Classroom #1 and Classroom#2. LPA observed sufficient amount of equipment, toys, tables, cots, and chairs during today's inspection. LPA observed a first aid kit available in the Toddler classroom. Medications will be stored in a locked box in the cabinet in the Toddler Classroom #2. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. LPA observed a combination smoke/carbon monoxide detector in the facility, in the Directors office. Per Applicant facility will utilize manual sign-in/sign-out system. Page 1

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: UCB CLARK KERR CAMPUS CHILDREN CENTER	FACILITY NUMBER: 013423781
	VISIT DATE: 09/03/2024

NARRATIVE

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LPA measured the Toddler classrooms. The total classroom space contains a total of 886.69 square feet, which will accommodate Applicant's request for 17 Toddler children. There is 2 toilets and 3 sinks for the children, and a separate private restroom for the staff is located in the facility. LPA observed changing table is in hands reach of a sink. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the Director's office and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
LPA measured the Toddler outdoor areas. The total outdoor space contains a total of 4778.98 square feet, which will accommodate Applicant's request for 17 Toddlers. There is 2 Toddler outdoor areas at the facility, the play yard 1 and play yard 2 outdoor play yard. The outdoor play area is fenced with wooden, concrete, and chain linked fencing that is at least four feet tall. There is a play structure in the upper play yard with tan bark surrounding the play structure. Play yard has rubber matting as cushioning to cushion a child's fall. LPA observed a sufficient amount of equipment and toys. LPA observed a sandbox in play yard 1, the upper play yard that was observed to be maintained and free of debris. There are no bodies of water on the premises. LPA reminded Director to ensure to empty all water tables when not in use. There is sufficient shading areas provided by trees and canopies in the play yard.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (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

LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: UCB CLARK KERR CAMPUS CHILDREN CENTER	FACILITY NUMBER: 013423781
	VISIT DATE: 09/03/2024

NARRATIVE

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Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Executive Director, Mosies Roman.

The following items are required before a license will be issued:

1. Licensing Program Manager (LPM) final file review.

2. Applicant must submit revised LIC500.
3. Applicant must submit revised LIC610.
4. Applicant must submit updated Parent Handbook.
5. Applicant must submit Toddler staff job description.

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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:	DATE: 09/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2024

LIC809 (FAS) - (06/04)

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