CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMPLAINT ... · , golden gate kids, llc ~ address )221-21st. avenue city i san francisco zip code 94710 i zip code zip code 94121 i i i i

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STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION

CCLD Regional Office, 1515 CLAY STREET, SUITE 1102 OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on 09/09/2013 and conducted by Evaluator Susan Neeson

FACILITY NAME: GOLDEN GATE KIDS ADMINISTRATOR: BRONSON, JANET ADDRESS: 1450 SIXTH ST CITY: BERKELEY CAPACITY: 32

MET WITH: Janet Bronson

ALLEGATION(S): 1 I Personal Rights 2 3 4 5 6 7 8 9

INVESTIGATION FINDINGS:

COMPLAINT CONTROL NUMBER: 02-CC-20130909130348

STATE: CENSUS: 18 UNANNOUNCED

FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED:

013420968 850

(51 0) 525-4841 94710

11/15/2013 08:00AM 09:00AM

1 2 3 4 5 6 7 8 9 10

The allegation is that a child's personal rights were not met at the facility because the child either got a bad diaper rash or that it was made worse when the staff failed to change the child when needed and left the child in soiled clothing. Parents were interviewed and predominantly were happy with the program and diapering issues.

It was not possible to determine if the rash the child suffered was caused by or made worse by staff at the facility.

This complaint is inconclusive.

11 I THIS IS A TYPED COPY OF THE HAND WRITIEN REPORT ISSUED DURING VISIT. 12 13

Inconclusive

SUPERVISOR'S NAME: Diane Perez

LICENSING EVALUATOR NAME: Susan Neeson

LICENSING EVALUATOR SIGNATURE:

Ztfl...(j\)

Estimated Days of Completion:

TELEPHONE: (510) 622-2592

TELEPHONE: (510) 622-2630

DATE: 11/19/2013

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04) Page: 1 of 2

/s-IS'~ STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGEN~ ¥-;/bz_ r\

~c..L/-1--N£)1 cA- CJ'tCn .-./ CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

COMMUNITY CARE LICENSING

COMPLAINT INVESTIGATION REPORT C) -z- c c- Z.OI'?:Joq

COMPLAINT CONTROL NUMBER 0 q /- 3 0 3' if$? This is an official report of an unannounced visi~~f a complaint received in our office on 9/9/13 and conducted by Evaluator ~ ~

FACILITY TYPE

ccc~P/5 FACILITY REPRESENTATIVE

TELEPHONE CENSUS

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ALLEGATION(S): flarYfht--~ ~t(k#

INVESTIGATION FINDINGS:

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D Substantiated ~ Inconclusive 0 Needs Further Investigation

D Unfounded Estimated Days of Completion

USE LIC 809 FOR ALL CITATIONS TIMEOUT TELEPHONE LICENSIN~GNN~ c9 t::tttrJ ( s-1 dJ ~ ·z_z-2t:;tt?

NAME OF SUPERVISOR

~ P?r, Distribution: Original: Agency LIC 9099 (5/00)

Duplicate: Licensee

TELEPHONE

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Triplicate: File.

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CCLD Regional Office 1515 CLAY STREET, SUITE 1102 OAKLAND, CA 94612

10/18/2013

GOLDEN GATE KIDS 013420968 5829 SUTIER AVE RICHMOND, CA 94710

Letter of Deficiency Citations Cleared Dear Licensee,

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CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DNISION

The following deficiencies, initially cited during a visit on 09/18/2013, have been cleared:

Section Cited: 101170 e 2 Plan of Correction: She is not to be present until proof of association with this facility has been obtained. A Civil Penalty of $500 was assessed. This is a zero tolerance deficiency.

LICENSING EVALUATOR NAME: Diane Perez


Date Due: 09/19/2013 Corrections: JESSICA BRONSON HAS BEEN ASSOCIATED TO THE FACILITY

Clearance Date: 09/23/2013

TELEPHONE: (510) 622-2592

DATE: 10/18/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) • (04/05) Page: 1 of 1

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ORIGINAL SIGNED BY SIGNATORY

. . ~ STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

'

CDSS DEPARTMENT OF SOCIAL SERVICES

1515 CLAY STREET, SUITE 1102 ,....--.....

WILL UGHTBOURNE DIRECTOR

OAKLAND, CA 94612

October 01, 2013

GOLDEN GATE KIDS- 013420968 221 -21ST AVE SAN FRANCISCO, CA 94121

THIS DOCUMENT CONTAINS

PENAL TV REVIEW Dear Ms. Bronson,

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E.IJMUNO G. BROWN JR. GOVERNOR

Per your request received in the licensing office on July 29, 2011, a review was made of the following Deficiency and/or Penalty Notice: Section 101170 (e)(2) -Criminal Record Clearance- Cited and subsequent civil penalty assessed during the September 18, 2013 Case Management Visit

The Results are as follows: [X] Penalty Assessment Dismissed [ ] Penalty Assessment Amount amended to: [ ] Extension of Correction Due Date Approved to: [] Extension Date Denied [ ] Request Denied

Date of Review Decision: October 1, 2013 Explanation: I have reviewed your request and discussed the deficiency with LPA Susan Neeson. I find the citation was correctly cited and the civil penalty appropriately assessed. However with the documentation submitted with your appeal I will waive the civil penalty but not the citation. In the future when sending in the Criminal Background Clearance Transfer Request please be sure to follow up with our office to ensure the request has been received and processed by our office. To that end please contact the licensing office should you have a question about the clearance status of any of your current or prospective employees.

Sincerely,

;;.-' ··~ r--'

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

NOTICE OF CIVIL PENALTIES DUE

.Amended IZI Initial Invoice 0 Final Notice Date Sent 10/3/2013

INVOICE NO. 0202529 REGIONAL OR COUNTY OFFICE NUMBER_02 ___ _

r FACILITY NAME

[GOLDEN GATE KIDS PHYSICAL ADDRESS

1450 SIXTH STREET CITY

[BERKELEY r MAILING ADDRESS

I I CITY /STATE

I' UCENSEE(S) OR UNLICENSED FACILITY OPERATOR

, GOLDEN GATE KIDS, LLC ~ ADDRESS

)221- 21ST. AVENUE CITY

I SAN FRANCISCO

ZIP CODE

94710

I ZIP CODE

ZIP CODE

94121

I I I

I

FISCAL YEAR

2013/2014 FACILITY TYPE

jDCC [ __ --

f FACILITY NUMBER

l013420968

SUPERVISOR APPROVAL

Cheryl Naumcheff TITLE

[Civil Penalty Coordinator

I DATE LIC 422 SENT

09/23/2013 PENALTY PCA CODE

84850

I DATE

1 09/23/2013

On 09/18/2013 your facility was found to be in violation of one or more sections of the California Health and Safety Code. DATE

See attached LIC 421 series form. As a result, you were assessed the following amount:

I (DATE)

Penalty Amount Oriainallv Assessed: 09/18/2013 $ 500.00 (DATE)

Penalty Amount Amended: 10/01/2013 $ (500.00) (DATE)

Payment Received: $ I l Balance Due: I $ 0.00

Send a copy of this notice and your payment to the address shown below within 10 days. MAKE CHECKS PAYABLE TO THE CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. Please write your invoice and facility number(s) on your check.

~o: CIVIL PENALTY COORDINATOR

:OMMUNITY CARE LICENSING/BARO

11515 CLAY STREET, SUITE 1102

[OAKLAND, CA 94612

FAILURE TO PAY CIVIL PENALTY MAY RESULT IN ANY OR ALL OF THE FOLLOWING:

• SEIZURE OF PERSONAL INCOME TAX REFUNDS

• LICENSE DENIAL, SUSPENSION, OR REVOCATION

• COURT ACTION

LIC 422 (9/11) (PUBLIC)

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i[ill\11 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY I I !I. !£ij

coss ,....--. Wlt.l UGHll!OURNE

OI~E:CTOR

October 01, 2013

DEPARTMENT OF SOCIAL SERVICES 1515GLAY STREET, SUITE 1102

OAKLAND, CA 94612

GOLDEN GATE KIDS- 013420968 221- 21ST AVE SAN FRANCISCO, CA 94121

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~ \iJ!/1 EtlMUND G, BROWN JR.

GOVERNOR

THIS DOCUMENT CONTAINS ~ INFORMATION

PENALTY REVIEW Dear Ms. Bronson,

Per your request received in the licensing office on July 29, 2011, a review was made of the following Deficiency and/or Penalty Notice: Section 101170 (e)(2)- Criminal Record Clearance- Cited and subsequent civil penalty assessed during the September 18, 2013 Case Management Visit

The Results are as follows: [X ] Penalty Assessment Dismissed [ ] Penalty Assessment Amount amended to: [ ] Extension of Correction Due Date Approved to: [ ] Extension Date Denied []Request Denied


Sincerely,

~~z UCEva~

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Golden Ga+e l<ids P R E S C H 0 0 L

California Department of social Services Community Care Ucensing Division CCLD Regional Office, 1515 Oay Street Ste. 1102 Oakland, CA. 94612 RE: Facility Site Visit9/18/2013

· Facility #013420968

September 19, 2013

Dear Licensing Program Manager Diane Perez:

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I am requesting an appeal regarding the citations received during a site visit conducted on our facility on September 18, 2013. The analyst Susan Neeson, arrived at 2:40pm. During her visit we received 2 Type A deficiencies; #101170e2 & 101229a1 which have both been corrected.

We are appealing based on these fact:

Citation 101170e 2 - Jessica Bronson. During our initial application, our original analyst Paulita Dela Cruz was provided with all the necessary documentations needed for licensing during the owners (Michelle Mendler) visit; this was at the Community Care Ucensing Facility where the documents were hand delivered to Ms. DelaCruz personally. I am including with this letter a copy of the original paperwork submitted (Emergency Disaster Plan for Child Care Centers) dated 10-12-12; the criminal background clearance transfer request dated August 13, 2012; and the facility evaluation report granting us the license for a capacity of 32 children on October 19,2012. During this time of approval we were under the assumption that all our teachers had been cleared and we were ready to start.

I would like to bring to your attention the dates in which the paper work was submitted and the date of which we were approved would lead me to believe that Ms. DelaCruz had reviewed all of our paperwork and all was cleared.

1450 Sixth Street, Berkeley CA 94710 510-525-4841 www.goldengate-kids.com

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Much to our surprise during this visit we were cited $500.00 with Ms. Bronson as not having clearance through fingerprints. We would never intentionally have had any teacher working in our facility without the proper clearance from DOJ knowing the severity of the consequences and jeopardize the safety of all the children under our care. We have learned a valuable lesson in making sure we do our own checks and balances especially when it comes to important documentation. I am hoping that you can grant us a reversal of the citation. Your understanding is greatly appreciated.

Citation 101229a1- We understand the importance of coverage and supervision and realize that there must be 2 supervising adults; 1 for each class. We were under the impression that having 1 teacher to 24 sleeping students was sufficient, we now have corrected this situation and have 1 teacher covering the toddler option students and 1 teacher covering the preschoolers. We apologize for this oversight and will not happen again; because we are a start-up preschool it is helpful to have your support and assistance in matters we lack in information and knowledge.

I also had a question regarding the paperwork issued, during the site visit Susan Neesons' printer was not working so she had me sign electronically. I am looking at a copy of the facility visit summary report. It states that it was an announced visit. Unfortunately we were not informed of this visit as I review the paperwork that was typed (printed) it states that it was an unannounced visit, so there are discrepancies in the paperwork For our edification we need to understand the paperwork involved.

We truly appreciate your consideration in granting us the opportunity to appeal. I can be confident in saying that we will be diligent in making sure all aspects of our facility is on top of the requirements of Community Care Licensing.

1450 Sixth Street, Berkeley CA 94710 510-525-4841 www.goldengate-kids.com

Sll\1}' ~NIA-HEAllli AND HUMAN SERVICES AGENC~ f'. CAUFOFINIA DEPARTMENT OF SOCIAL SERVICES

FACILITY VISIT SUMMARY REPORT Complaint Control Number.

I ADMINISTRATOFI

ADDRESS

9 o/'?!o1 ($/Vs-z_,-.. '1~'11 1 '1-t:o TYPE OF VISIT MET

~Complaint 0 Random

0 Prelicensing 0 POC ~ Management D Required

DEFICIENCY/CML PENALTY INFORMATION

)d Type A 0 Civil Penalty Assessed

0 Type B 0 Penalty Notice Given

D No Deficiency Cited 0 Penalty Cleared

AREA OF DEFICIENCY(IES}

D Program/Operation

FACIUTY NUMBER

&13 z.oqG J{' Fc~Z~PLs-CAPACITY CENSUS

3Z 7-/ 2--B/3 ,

~ Announced z:<;D I TIME COMPLETED

D Unannounced b :· o-::J

0 Penalty Not Cleared

0 Deficiencies Cleared

D Deficiencies Not Cleared

D Staffing/Ratio 0 Umits of license

Ji5( Criminal Re00rd

0 Records D Health Related/Medical Services D Physical Plant

18' Care and Supervision 0 Personal Rights

0 Food Service D Qualifications 0 Other

Defi • Descrioti r To Be Corrected Bv Dat1 - _ aon .• -

/Pl 17D e -z, (Jte-t-111. 0t..-ttR. R~_w d ~¢~ 0/;<t/201 3 c f' t'!f.- f/6lJ-o ~~ l I

-/ tJ IZ~~· 0t I ' Cc:We. a ~~..,..-l/1..-~ &:JIIf' /Zc,Y I '3 . v l • (

SUPERVISO~ NAME

.{) ~ ' -.u-.u;~') T~ONE

(sit) b ZZ--2& oZ UCENSING EVAlUATOR-NliME TELEPHONE

·l _<S_l\l~ ---- ------ -------- ---·- -·----- ------~--------~--- - -------

u;w.:wNt~fruS,~ rATE gj;<f.) Zo /3 I have read and understand the electronic version of the full licensing report completed today at this facility. I acknowledge receipt of this fonn and understand my appeal rights as explained on the back of this fonn. If "A" violations are cited, child care providers must post this reg.Qrt pending receipt of final report. FACILITY FIEPRESENTATNE SIGNATURE

.OVIDING A PRINTED COPY OF THE ELECTRONIC REPORT TO THE LICENSEE:

LIC 809S (8/04)

I certify that the attached is a true and correct copy of the electronic field visit report completed at the facility

on ---------------={o~ate~)----------------

(LPA Signature} {Date)

PAGEt OF2

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FACILITY EVALUATION REPORT

FACILITY NAME: GOLDEN GATE KIDS ADMINISTRATOR: BRONSON, JANET ADDRESS: 1450 SIXTH ST CITY: BERKELEY CAPACITY: 32 TYPE OF VISIT: Case Management MET WITH: Janet Bronson

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STATE:CA CENSUS: 21 UNANNOUNCED

FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED:

013420968 850

(51 0) 525-4841 94710

09/18/2013 02:40PM 05:00PM

NARRATIVE 1 An unannounced Case Management site visit was conducted by LPA Susan Neeson. Met with Janet 2 Bronson. 3 4 List of staff was reviewed. 5 6 A tour of the facility was done. Children were observed at nap. 3 toddler option children were observed 7 sleeping in a room without any supervision. There is one staff person whose fingerprints are not associated 8 with the facility. The play yard is being renovated. Workmen and equipment are in the yard. It is currently 9 unsafe and unavailable for children to play. Janet Bronson stated that information about the work on the yard 1 0 was given to the Department. Nontheless, authorization for use of alternative space should have been 11 obtained before the work began. 12 13 Snack and lunch service menus were discussed. 14 15 AB 633 fact sheet was issued. 16 17 Deficiencies are cited on LIC 809 D. 18 19 Appeal Rights were discussed. 20 21 An exit interview was given. 22 23 The typed report will be mailed. It could not be printed today for technical reasons. 24 25




TELEPHONE: (510) 622-2592

TELEPHONE: (510) 622-2630

7dt._l\{~ DATE: 09/18/2013

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


DATE: 09/18/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LICB09 (FAS) - (06/04) Page: 1 of2

, ... ,.,,. (',


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FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 1515 CLAY STREET, SUITE 1102 OAKLAND, CA 94612

FACILITY NAME: GOLDEN GATE KIDS

DEFICIENCY INFORMATION FOR THIS PAGE: FACILITY NUMBER: 013420968

VISIT DATE: 09/18/2013

Deficiency Type POC Due Date I DEFICIENCIES PLAN OF CORRECTIONS(POCs) Section Number

1 Criminal Record Clearance. Prior to working or 1 She is not to be present until proof of association

2 volunteering in a licensed child care facility, all 2 with this facility has been obtained. Type A 3 individuals subject to a criminal record review shall 3 A Civil Penalty of $500 was assessed.

09/19/2013 4 request a transfer of a criminal record clearance 4 This is a zero tolerance deficiency. Section Cited 5 from another facility or Trustline. Jessica 5

101170 e 2 6 Bronson's fingerprints are not associated with this 6 7 facility. 7

f

~ 1 Care and Supervision. No child(ren) shall be left 1 Children are to be visually supervised at all times.

2 without the supervision, including visual 2 Type A 3 observation, of a teacher at any time except as 3 This is a zero tolerance deficiency.

09/19/2013 4 specified in sections 1 01216.2(e)(1) and 4 Section Cited 5 1 01230(c)(1 ). Three of the toddler option children 5

101229 a 1 6 were napping in a room without an adult 6 7 supervising them. 7

1 1 2 2 3 3 4 4 5 5 6 6 7 7

1 1 2 2 3 3 4 4 5 5 6 6 7 7

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: Diane Perez TELEPHONE: (510) 622-2592



TELEPHONE: (510) 622-2630

~~1\f~ DATE: 09/18/2013



This Notice must be posted for 30 days

LICB09 (FAS)- (06/04)

DATE: 09/18/2013

Page: 2 of2

~

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office 1515 CLAY STREET, SUITE 1102 OAKLAND, CA 94612

11/14/2013

GOLDEN GATE KIDS 013420968 5829 SUTTER AVE RICHMOND, CA 94710

Letter of Deficiency Citations Cleared Dear Licensee,

?"'""'


The following deficiencies, initially cited during a visit on 09/18/2013, have been cleared:

Section Cited: 101170 e 2 Plan of Correction: She is not to be present until proof of association with this facility has been obtained. A Civil Penalty of $500 was assessed. This is a zero tolerance deficiency.

Section Cited: 101229 a 1 Plan of Correction: Children are to be visually supervised at all times.

This is a zero tolerance deficiency.



~rtf--~

Date Due: 09/19/2013 Corrections: JESSICA BRONSON HAS BEEN ASSOCIATED TO THE FACILITY

Date Due: 09/19/2013 Corrections: Letter received Sept. 20, 2013 that deficiency had been corrected.



TELEPHONE: (510) 622-2630

DATE: 09/23/2013

This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) - {04/05) Page: 1 of 1

[]] • .

CDSS ,----. Wlll UGHTBOURNE

DiRECTOR

October 01, 2013

/,--...


DEPARTMENT OF SOCIAL SERVICES 1515GLAY STREET, SUITE 1102

OAKLAND, CA 94612

GOLDEN GATE KIDS- 013420968 221- 21ST AVE SAN FRANCISCO, CA 94121

~

EDMUND G. BROWN JR. GOVERNOR

Rtbl[C THIS DOCUMENT CONTAINS OONFIB!1iif1Al INFORMATION

PENALTY REVIEW Dear Ms. Bronson,

Per your request received in the licensing office on July 29, 2011, a review was made of the following Deficiency and/or Penalty Notice: Section 101170 (e)(2)- Criminal Record Clearance- Cited and subsequent civil penalty assessed during the September 18, 2013 Case Management Visit

The Results are as follows: [X ] Penalty Assessment Dismissed [ ] Penalty Assessment Amount amended to: []Extension of Correction Due Date Approved to: [ ] Extension Date Denied []Request Denied


~



FACILITY NAME: GOLDEN GATE KIDS ADMINISTRATOR: BRONSON, JANET ADDRESS: 1450 SIXTH ST CITY: BERKELEY CAPACITY: 32 TYPE OF VISIT: Office MET WITH: Michelle Mendler

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CCLD Regional Office, 1515 CLAY STREET, SUITE 1102 OAKLAND, CA94612

FACILITY NUMBER: FACILITY TYPE: TELEPHONE:


ZIP CODE: DATE: TIME BEGAN:

013420968 850

(51 0) 525-4841 94710

09/19/2013 01:15PM 02:10PM TIME COMPLETED:

NARRATIVE 1 The following deficiency is cited which was observed 9/18/18 at the facility. 2 3 Deficiency is cited on LIC 809 D. 4 5 Appeal Rights were discussed. 6 7 Proof of corrections form was issued. 8 9 LIC 9224 was issued. 10 11 Copy of profile and personnel list was issued. 12 13 An exit interview was given. 14 15 16 17 18 19 20 21 22 23 24 25




~/\]~

TELEPHONE: (510) 622-2592

TELEPHONE: (510) 622-2630

DATE: 09/19/2013



\ hr\Ar-...__..1 DATE: 09/19/2013


LIC809 (FAS) - (06/04) Page: 1 of2

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FACILITY EVALUATION REPORT (Cont)

FACILITY NAME: GOLDEN GATE KIDS DEFICIENCY INFORMATION FOR THIS PAGE:

Deficiency Type POC Due Date I DEFICIENCIES Section Number

1 Alterations to Existing Buildings or New Facilities

Type B 2 Prior to construction or alterations, the licensee

09/23/2013 3 shall notify the Department of the proposed

Section Cited 4 change(s). Building inspection by local inspector 5 and permit is required. Also, alternatives to using

101237 a 6 the outdoor space and how the area will be safely 7 off-limits while work is done needs to be submitted.

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

0


CCLD Regional Offlce,1515 CLAY STREET, SUITE 1102 OAKLAND, CA 94612

FACILITY NUMBER: 013420968 VISIT DATE: 09/19/2013

PLAN OF CORRECTIONS(POCs)

Submit by 9/23/13.

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: Diane Perez TELEPHONE: (51 0) 622-2592



TELEPHONE: (510) 622-2630

~ IV PJM--1'- DATE: 09/19/2013



t\1\ DATE: 09/19/2013

LIC809 (FAS) - (06/04) Page: 2 of2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENC(' 0 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

FACILITY VISIT SUMMARY REPORT Complaint Control Number:

FACILITY NUMBER I FACILITY TYPE /_ .

&13vUJq(?{ ccc-ft3 ADDRESS

I ~?;IJ T(5-?v>zs-.,v&'VIICA3TYz lc~u/ I i/1~/UJ-t"$ TYPE OF VISIT

~Complaint 0 Random

0 Prelicensing 0 POC I _) Q A>

~ Management 0 Required 1 DO{ M 5 (J-A-

DEFICIENCY/CIVIL PENALTY INFORMATION

pi/ Type A 0 Civil Penalty Assessed

0 Type B 0 Penalty Notice Given

0 No Deficiency Cited 0 Penalty Cleared

AREA OF DEFICIENCY(IES)

0 Limits of License

~ Criminal Record 0 Records

0 Food Service

Deficiency Description

/PI 110 e z_

0 Program/Operation

0 Health Related/Medical Services

0 Physical Plant

0 Qualifications

U4rrn~ R~d ~f7~ 0 t tr/-- (II Qro ,/11_ A II Ad'ld ;._.-//

I/JIZ29' Vt I I [!__a-re_ ck <ZA.- A//" /IV~ c:f_""T'f'""'""''

v

SUPERVISOA NAME

tJ, ~~ LICENSING EVALUATOR--Mli"ME

S,tl~ LICENSING EVALUATOR SIGNATURE

~ rJt, f &tt-.r-

~ Announced z:<~u TIME COMPLETED

0 Unannounced 6 .' c;rO

0 Penalty Not Cleared

0 Deficiencies Cleared

0 Deficiencies Not Cleared

0 Staffing/Ratio

~ Care and Supervision

0 Personal Rights

0 Other

To Be Corrected By Date

0;/;Cf/ZM 3 l f

1Jtq_jz~ 15 ' . (

T~~~) 6 2?- 2& l) z TELEPHONE

•(

DATE g j;g") zo 13 I have read and understand the electronic version of the full licensing report completed today at this facility. I acknowledge receipt of this form and understand my appeal rights as explained on the back of this form. If "A" violations are cited, child care providers must post this reBQrt pending receipt of final report. FACILITY REPRESENTATIVE SIGNATURE

OVIDING A PRINTED COPY OF THE ELECTRONIC REPORT TO THE LICENSEE:

I certify that the attached is a true and correct copy of the electronic field visit report completed at the facility

on (Date)

(LPA Signature) (Date)

LIC 809S (8/04) PAGE 1 OF2

//

0




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CCLD Regional Offlce,1515 CLAY STREET, SUITE 1102 OAKLAND, CA 94612

FACILITY NUMBER: FACILITY TYPE: TELEPHONE:


ZIP CODE: DATE: TIME BEGAN:

013420968 850

(51 0) 525-4841 94710

09/19/2013 01:15PM 02:10PM TIME COMPLETED:

NARRATIVE 1 The following deficiency is cited which was observed 9/18/18 at the facility. 2 3 Deficiency is cited on LIC 809 D. 4 5 Appeal Rights were discussed. 6 7 Proof of corrections form was issued. 8 9 LIC 9224 was issued. 10 11 Copy of profile and personnel list was issued. 12 13 An exit interview was given. 14 15 16 17 18 19 20 21 22 23 24 25




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TELEPHONE: (510) 622-2592

TELEPHONE: (510) 622-2630

DATE: 09/19/2013



l hr\A..........._.J DATE: 09/19/2013


LICB09 (FAS) - (06/04) Page: 1 of2

('


FACILITY EVALUATION REPORT (Cant)


DEFICIENCY INFORMATION FOR THIS PAGE:

Deficiency Type POC Due Date I DEFICIENCIES Section Number

1 Alterations to Existing Buildings or New Facilities Type B 2 Prior to construction or alterations, the licensee

09/23/2013 3 shall notify the Department of the proposed

Section Cited 4 change(s). Building inspection by local inspector 5 and permit is required. Also, alternatives to using

101237 a 6 the outdoor space and how the area will be safely 7 off-limits while work is done needs to be submitted.

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

--- -- - - -

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

0


CCLD Regional Office, 1515 CLAY STREET, SUITE 1102 OAKLAND, CA94612


PLAN OF CORRECTIONS(POCs)

Submit by 9/23/13.

...._ ------------




7;(l 1\1~ TELEPHONE: (510) 622-2630

DATE: 09/19/2013



(!./\ DATE: 09/19/2013

LIC809 (FAS) - (06/04) Page: 2 of2

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013420968 850

(51 0) 525-4841 94710

09/18/2013 02:40PM 05:00PM

NARRATIVE 1 An unannounced Case Management site visit was conducted by LPA Susan Neeson. Met with Janet 2 Bronson. 3 4 List of staff was reviewed. 5 6 A tour of the facility was done. Children were observed at nap. 3 toddler option children were observed 7 sleeping in a room without any supervision. There is one staff person whose fingerprints are not associated 8 with the facility. The play yard is being renovated. Workmen and equipment are in the yard. It is currently 9 unsafe and unavailable for children to play. Janet Bronson stated that information about the work on the yard 10 was given to the Department. Nontheless, authorization for use of alternative space should have been 11 obtained before the work began. 12 13 Snack and lunch service menus were discussed. 14 15 AB 633 fact sheet was issued. 16 17 Deficiencies are cited on LIC 809 D. 18 19 Appeal Rights were discussed. 20 21 An exit interview was given. 22 23 The typed report will be mailed. It could not be printed today for technical reasons. 24 25




TELEPHONE: (510) 622-2592

TELEPHONE: (510) 622-2630

7PLrV~ DATE: 09/18/2013



DATE: 09/18/2013


LIC809 (FAS) - (06/04) Page: 1 of2

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0




DEFICIENCY INFORMATION FOR THIS PAGE: FACILITY NUMBER: 013420968

VISIT DATE: 09/18/2013






1 Care and Supervision. No child(ren) shall be left 1 Children are to be visually supervised at all times.


09/19/2013 4 specified in sections 1 01216.2(e)(1) and 4 Section Cited 5 101230(c}(1). Three of the toddler option children 5

1 01229 a 1 6 were napping in a room without an adult 6 7 supervising them. 7

1 1 2 2 3 3 4 4 5 5 6 6 7 7

1 1 2 2 3 3 4 4 5 5 6 6 7 7

- --- --- -- - - -- -- - - -- l__j_ _________________ _




TELEPHONE: (510) 622-2630

717~1\f~ DATE: 09/18/2013



DATE: 09/18/2013


LICB09 (FAS) - (06/04) Page: 2 of 2

0 ('


NOTICE OF CIVIL PENALTIES DUE

Ill Initial Invoice D Final Notice Date Sent 9/23/2013

INVOICE NO. 0202529 REGIONAL OR COUNTY OFFICE NUMBER_0_2 __ _

FACILITY NAME

GOLDEN GATE KIDS PHYSICAL ADDRESS

1450 SIXTH STREET CITY I STATE I ZIP CODE

BERKELEY CA 94710 MAILING ADDRESS

CITY I STAT: _lz:CODE

I LICENSEE(S) OR UNLICENSED FACILITY OPERATOR

GOLDEN GATE KIDS, LLC ADDRESS

221- 21ST. AVENUE CITY ZIP CODE

SAN FRANCISCO 94121

FISCAL YEAR

2013/2014

FACILITY TYPE

DCC

[

FACILITY NUMBER

013420968

SUPERVISOR APPROVAL

Cheryl Naumcheff TITLE

Civil Penalty Coordinator

DATE LIC 422 SENT

09/23/2013 PENALTY PCA CODE

84850

1DATE

1 09/23/2013

On 09/18/2013 your facility was found to be in violation of one or more sections of the California Health and Safety Code. DATE

See attached LIC 421 series form. As a result, you were assessed the following amount:

(DATE)

Penalty Amount Oriainally Assessed: 09/18/2013 $ 500.00 (DATE)

Penaltv Amount Amended: $ (DATE)

Payment Received: $

Balance Due: $ 500.00 -1

Send a copy of this notice and your payment to the address shown below within 10 days. MAKE CHECKS PAYABLE TO THE CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. Please write your invoice and facility number(s) on your check.

To: CIVIL PENALTY COORDINATOR

COMMUNITY CARE LICENSING/BARO

1515 CLAY STREET, SUITE 1102

OAKLAND, CA 94612

FAILURE TO PAY CIVIL PENALTY MAY RESULT IN ANY OR ALL OF THE FOLLOWING:

• SEIZURE OF PERSONAL INCOME TAX REFUNDS

• LICENSE DENIAL, SUSPENSION, OR REVOCATION

• COURT ACTION

LIC 422 (9/11) (PUBLIC)

'0 f"' STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

CIVIL PENALTY ASSESSMENT- IMMEDIATE

FACILITY NAME DATE

Golden Gate Kids 09/18/2013 FACILITY ADDRESS CITY STATE ZIP CODE

1450 Sixth St. Berkeley CA 94710 OPERATOR(S) FACILITY# IF LICENSED OR PENDING:

Golden Gate Kids, LLC t!J(~t.( 209&51 Immediate civil penalties can be assessed against any licensee for failure to comply with Caregiver Background Check requirements and against family child care licensees for failure to comply with parent/authorized representative (AR) notification and visit report posting requirements. See the back of this form for specifics.

On this date you have been found in violation of one or more requirements for which an immediate civil penalty is warranted. See the Licensing Report (LIC 809 or LIC 9099) issued on this date. You are hereby notified that a civil penalty has been assessed.

Caregiver Background Check 0 $100 immediate Civil Penalty per person for allowing any person (who is subject to a background check) to work, reside or

volunteer without a criminal record clearance or exemption. Maximum of 5 days for the first violation. Maximum 30 days for subsequent violations.

0 $100 immediate Civil Penalty per person for allowing any person (who is subject to a Caregiver Background Check Order of Removal) to work, reside or volunteer.

Gll $100 immediate Civil Penalty per person for allowing a cleared or exempted person to work, reside or volunteer before requesting a clearance transfer or before receiving approval of an exemption transfer.

\A JA~ 'A..-~~ Individual #1 ~ number of days x $100 = $ 500.00 Penalty

Individual #2

Individual #3

Child Care Facilities Only

number of days x $100 = $. ___ _

number of days x $100 = $. ___ _

Penalty

Penalty

0 $100 immediate Civil Penalty per parent/AR for failure to provide "Family Child Care Home (FCCH) Addendum to

Notification of Parents' Rights (Regarding Exclusion)".# parent/ AR x $100 = $ penalty

0 $100 immediate Civil Penalty per parent/AR for failure to provide "Family Child Care Home Addendum to Notification of Parents' Rights (Regarding Reinstatement)". # parent/AR x $100 = $ penalty

0 $100 immediate Civil Penalty per parent/AR for failure to obtain signature indicating receipt of Addendum. # parent/AR x $100 = $ penalty

0 $100 immediate Civil Penalty for failure to provide signed addendum to the Department when requested.

0 $1 00 immediate Civil Penalty for failure to comply with posting requirements for 30 consecutive days.

0 $50 immediate Civil Penalty for failure to return "Confirmation of Removal" form to Licensing within 5 days. (FCCH only)

Total PenaltyAssessed $ ____ _

YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE.

SIG~G/J~ 09/18/2013

NAME OF LICENSING PROGRAM ANALYST DATE

Susan Neeson

NAME OF FACILITY REPRESENTATIVE/TITLE SIGNATURE OF FACILITY REPRESENTATIVE DATE

Michelle MMendler 09/18/2013

SUPERVISOR REVIEW/SIGNATU

", TITLE(_jtn ·1- DATE

UC421B (7/11)

0 0

CIVIL PENALTIES COMPUTATION * Dd.D8.5J, (1.

ClJl Amount-of the first day1s civil penalty:

[ J $50 [ J $.150 (IMMEDIATE CP) [ J $200 (UNLICENSED CP) = $

1!1 $1 00 (IMMEDIATE FINGERPRINT CP). X ~ (INDIVIDUALS)

@ Plus amount of subsequent d'aily civil penalties:

[ ] $50 (REG. & !MM. CP) [ J $150 {2ND IM.M. CP) [ ] $200 (UNLICENSED CP)

-7' multiply by# of days* ___ _ = $ __ _

* -y; {count from the day after the cp started th rouah the day the cp stopped)

the total amount of civil penalties:

LPk ~~ LPS. . .

ctl-0 = $ g{Jf; JZy:;

DATE: ({ !11 lrq.t3 DATE: q.J~j

(}·Equals

\ttach this signed form to the case file and route to the civil penalty clerk for billing.

:ase file will be_ returned t~r:e ~LP1' or __ the LPS for revier~ ·,. (7 After billing, the

)ATE PROCESSED: q f d 2:, f '--~ ·· BY: \ &../~p/1 'f'-. . '\ I I

. ( 3AD033 2/98)

~




~



STATE: CA CENSUS: 21 UNANNOUNCED


013420968 850

(51 0) 525-4841 94710

09/18/2013 02:40PM 05:00PM

NARRATIVE 1 An unannounced Case Management site visit was conducted by LPA Susan Neeson. Met with Janet 2 Bronson. 3 4 List of staff was reviewed. 5 6 A tour of the facility was done. Children were observed at nap. 3 toddler option children were observed 7 sleeping in a room without any supervision. There is one staff person whose fingerprints are not associated 8 with the facility. The play yard is being renovated. Workmen and equipment are in the yard. It is currently 9 unsafe and unavailable for children to play. Janet Bronson stated that information about the work on the yard 1 0 was given to the Department. Nontheless, authorization for use of alternative space should have been 11 obtained before the work began. 12 13 Snack and lunch service menus were discussed. 14 15 AB 633 fact sheet was issued. 16 17 Deficiencies are cited on LIC 809 D. 18 19 Appeal Rights were discussed. 20 21 An exit interview was given. 22 23 The typed report will be mailed. It could not be printed today for technical reasons. 24 25




7ftL f\{~

TELEPHONE: (510) 622-2592

TELEPHONE: (510) 622-2630

DATE: 09/18/2013



DATE: 09/18/2013


LICB09 (FAS) - (06/04) Page: 1 of2

//

0,


0












09/19/2013 4 specified in sections 1 01216.2(e}(1) and 4 Section Cited 5 1 01230(c)(1 ). Three of the toddler option children 5

101229 a 1 6 were napping in a room without an adult 6 7 supervising them. 7

1 1 2 2 3 3 4 4 5 5 6 6 7 7

1 1 2 2 3 3 4 4 5 5 6 6 7 7




TELEPHONE: (510) 622-2630

77"1\J~ DATE: 09/18/2013



DATE: 09/18/2013


LIC809 (FAS) - (06/04)

/

Page: 2 of 2

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CIVIL PENALTY LEDGER

INVOICE NO. o2o2529 REGIONAL OFFICE NUMBER 02 -------------------- ----

IFACILrTYNAME- - - - --

1 GOLDEN GATE KIDS I FACILITY ADDRESS ---1

: 1450 SIXTH STREET I_--jClTY

BERKELEY

LICENSEE(S) OR UNLICENSED FACILITY OPERATOR

GOLDEN GATE KIDS, LLC ~-ADDRESS

r 221- 21ST. AVENUE i-jCITY

SAN FRANCISCO

!Original Invoice Amount Assessed I

i i ----- - ---- - -----[Civil Penalty Amended Amount

Civil Penalty Amended Amount

STATE

CA

STATE

CA

FISCAL YEAR ' DATE LIC 422 SENT -~- ---

• 2013/2014 i, 09/23/2013 ' FACILITY TYPE i FACILITY PCA CODE

I DCC 84850 ~----- ·------

ZIP CODE

94710

I FACILITY NUMElER--- - -----------------

l__<J_134209~~-

ZIP CODE

94121

DATE AMOUI\J_l___ CUMUL~TIVI; BALANCE

09/18/2013 $500.00 $500.00

. ----------------------· ------------ - ----,-------------------•pvil Penalty Amended Amount

i -!Payment

i !Payment

]Payment

\Payment

!Payment

Payment

COMMENTS:

UC 422A (7/11)

-------- ----------~-----

-_-:::_______ -------------------------~::::--=-=-=-----

(~

v· - ..

,.- .. STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY

PROOF OF CORRECTION

FACILITY NAME: FACILITY NUMBER:

GOLDEN GATE KIDS 013420968

0



LICENSING EVALUATOR:

Susan Neeson

This form shall be used in conjunction with the Licensing Report (LIC 809) and is provided to the facility to verify the

correction of deficiency(ies) cited in a licensing visit to your facility on 09/18/2013. The use of this form will not

prohibit the Licensing Evaluator from conducting follow-up visits to ensure that deficiencies are corrected. (See

instructions on page 2).

PROOF OF CORRECTION

DEFICIENCY(IES) PICTURE RECEIPT PHOTO- *CERTIFICATION OTHER DATE

SECTION NUMBER COPY CORRECTED

1. \O(t"lOe :J... \1 q I rglt3' 2. IOIU'-lctl v qfr<bfr~' 3.

4.

5.

6.

7.

8.

9.

I certify, under penalty of perjury under the laws of the State of California, that the above is true and correct and that I have corrected all deficiencies above on or before the date(s) indicated.

DATE

qJ~l t3 *Certification -/this box may be checked if there is no other means to verify that the deficiency has been corrected. By signing\tb.i$ form, the licensee is self-certifying that the corrections have been made. If the certification is related to fingerprints, include the name(s) of the individual(s) for which the fingerprint card was submitted and insert the date submitted to the Department of Justice in the "Data Corrected" column.

PLEASE RETURN THIS FORM WITH YOUR PROOF OF CORRECTION(S)

LIC909B (FAS) - (3/00) Page: 1 of2

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013420968 850

(510) 525-4841 94710

09/18/2013 02:40PM 05:00PM

NARRATIVE 1 2 3

An unannounced Case Management site visit was conducted by LPA Susan Neeson. Met with Janet Bronson.

4 I List of staff was reviewed. 5 6 7 8 9 10 11 12 13 14

A tour of the facility was done. Children were observed at nap. 3 toddler option children were observed sleeping in a room without any supervision. There is one staff person whose fingerprints are not associated with the facility. The play yard is being renovated. Workmen and equipment are in the yard. It is currently unsafe and unavailable for children to play. Janet Bronson stated that information about the work on the yard was given to the Department. Nontheless, authorization for use of alternative space should have been obtained before the work began.

Snack and lunch service menus were discussed.

15 AB 633 fact sheet was issued. 16 17 Deficiencies are cited on LIC 809 D. 18 19 Appeal Rights were discussed. 20 21 An exit interview was given. 22 23 24 25

The typed report will be mailed. It could not be printed today for technical reasons.




TELEPHONE: (510) 622-2592

TELEPHONE: (510) 622-2630

7ntrV~ DATE: 09/18/2013



DATE: 09/18/2013


LIC809 (FAS) - (06/04) Page: 1 of2

~ .

STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION









f


~ 2 without the supervision, including visual 2

Type A 3 observation, of a teacher at any time except as 3 This is a zero tolerance deficiency. 09/19/2013 4 specified in sections 101216.2(e)(1} and 4

Section Cited 5 1 01230(c)(1 }. Three of the toddler option children 5 101 229 a 1 6 were napping in a room without an adult 6

7 supervising them. 7

1 1 2 2 3 3 4 4 5 5 6 6 7 7

1 1 2 2 3 3 4 4 5 5 6 6 7 7

-- -· -- --- ________________ ___JL__L__ ________________ _

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: Diane Perez



7;;~1\f~

TELEPHONE: (510) 622-2592

TELEPHONE: (51 0) 622-2630

DATE: 09/18/2013




LIC809 (FAS) - (06/04)

DATE: 09/18/2013

Page: 2 of2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY


FACILITY NAME: GOLDEN GATE KIDS ADMINISTRATOR: BRONSON, JANET ADDRESS: 1450 SIXTH ST CITY: BERKELEY CAPACITY: 30 TYPE OF VISIT: Prelicensing

STATE:CA CENSUS:O ANNOUNCED

MET WITH: Michelle Mendler & Janet Bronson

NARRATIVE




013420968 850

{51 0) 525-4841 94710

10/19/2012 10:17 AM 02:15PM

1 A Prelicensing Visit was conducted on this date by LPA, Paulita De La Cruz. LPA met with the applicant, 2 Michelle Mendler and center director, Janet Bronson. The applicant has applied for a preschool program with 3 a toddler-option . A health and safety inspection was conducted inside and outside and measurements are as 4 follows: 5 6 INDOORS: 2203.98 square feet accommodates 62 children 7 OUTDOORS: 1251 .68 square feet accommodates 16 chi ldren 8 9 The center is equipped with varied age appropriate materials and equipment inside and outside. First aid 10 supplies are available. There are 3 toilets and 9 sinks available for children. The adult bathroom located 11 closest to the reception area and the director's office will serve as isolation areas. The play yard is fenced in 12 all around and the small cl imbing structure is cushioned with poured rubber. There is a functioning drinking 13 fountain inside and a water "jug" and cups will be used in the play yard to provide water for the children . A 14 waiver request was received for the shared use of the play yard between the toddler-option and preschool 15 programs and to be licensed for 32 children inside and 16 children outside. An exception request was also 16 submitted for Janet Bronson who has completed 12 ECE units and is currently enrolled in ECE Administration 17 course that will be completed in December 2012. The applicant has obtained an approved fire safety 18 inspection on 9/12/2012 and the report was received by LPA on 9/12/2012. All applicants and the director are 19 fingerprint cleared. Zero Tolerance policies and appeal rights process were explained . All corrections to the 20 application package were received during this visit. The center was found to be clean, safe, sanitary, and in 21 good repair. 22 23 A license for 32 children will be issued effective 10/19/2012. An exit interview was conducted. 24 25

SUPERVISOR'S NAME: Glenn A Schnell

LICENSING EVALUATOR NAME: Paulita DelaCruz

TELEPHONE: (51 0) 622-2592

TELEPHONE: {510) 542-4257

a ::: j'' DATE: 10/19/2012



Q DATE: 10/19/2012


LIC809 ( F AS) - (06104) Page: 1 of 1




STATE:CA CENSUS: 0 ANNOUNCED

NARRATIVE


CCLD Regional Offlce, 1515 CLAY STREET, SUITE 1102 OAKLAND, CA 94612


013420968 850

(51 0) 525-4841 94710

10/11 /2012 08:55AM 11:00 AM

1 Licensing Program Analyst (LPA), Paulita De La Cruz, met with applicant, Michelle Mendler. Ms. Mendler's 2 husband, Benjamin Mendler, is also an applicant but he was not present during this meeting. The applicants 3 have submitted an application for a brand new combination center, preschool and infant program. 4 5 The applicants have obtained an approved fire safety inspection on 9/12/2012. The applicants are both 6 fingerprint cleared. Ms. Mendler is also a licensed family child care home provider in San Francisco, License 7 #384000173. Ms. Mendler will be hiring a fully-qualified director to operate her center. 8 9 Corrections to application package was discussed. A Prelicensing Visit is scheduled for October 19, 2012. 10 11 An exit interview was conducted. 12 13 14 15 16 17 18 19 20 21 22 23 24 25

SUPERVISOR'S NAME: Glenn A Schnell

LICENSING EVALUATOR NAME: Paulita DelaCruz


TELEPHONE: (51 0) 622-2592

TELEPHONE: (510) 542-4257

DATE: 10/11/2012

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


DATE: 10/11/2012


LIC809 (FAS)- (06/04) Page: 1 of 1

Documents

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMPLAINT ... · , golden gate kids, llc ~ address )221-21st. avenue city i san francisco zip code 94710 i zip code zip code 94121 i i i i