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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010200370
Report Date: 08/24/2021
Date Signed: 08/24/2021 02:40:22 PM

Document Has Been Signed on 08/24/2021 02:40 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:LAKESHORE CHILDREN'S CENTERFACILITY NUMBER:
010200370
ADMINISTRATOR:THOMPSON, RAE RITA FFACILITY TYPE:
850
ADDRESS:3518-3546 LAKESHORE AVENUETELEPHONE:
(510) 893-4048
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY: 49TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
08/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Rae Rita ThompsonTIME COMPLETED:
02:45 PM
NARRATIVE
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On 8/24/21 at 09:05am, Licensing Program Manager (LPM) Loretta Dyson arrived at the facility for an unannounced 1 year required inspection. LPM met with Rae Rita Thompson, the director. There were 9 children and 2 additional staff also present. The facility currently operates Monday-Friday 8am-5pm. The preschool program is one component of this combination facility which also has a school age component.

The preschool operates in two buildings, the Kleines Haus and Kinder Haus. LPM completed a tour of both buildings, including the classrooms, bathrooms and the kitchen area, and the outdoor play area to conduct a health and safety inspection. LPM observed that all of the classrooms have sufficient heating, lighting and ventilation for the safety and comfort of children and staff. The classroom floors and surfaces appear to be safe and in good repair. There is an ample supply of age appropriate furniture, toys, activities and equipment which appear to be in good condition and safe. There is adequate storage for children's belongings. The cots and mats are stored appropriately, and there is a sufficient supply for the amount of children enrolled. The 4 toilets and 6 sinks available to children are in sanitary and operational condition today, and there is a separate bathroom for staff. LPM observed that the kitchen area is clean, free from hazards and adequately equipped. The facility serves snacks to children and families bring lunch from home. LPM did not observe any food stored with cleaning supplies. Each child has their individual water bottle and staff refill them as needed, so water is available both indoors and outdoors.

The outdoor play are is fully fenced and there is a sufficient amount of shade from the trees and canopy. There is an ample supply of age appropriate equipment and the play structure is anchored and secure and has sand underneath for cushioning, to absorb the impact from a fall. LPM observed that the outdoor surfaces are free from hazards. LPM did not observe any bodies of water, hazardous items, toxins or medication accessible to children today.
**************************************************************************continued on 809C
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: LAKESHORE CHILDREN'S CENTER
FACILITY NUMBER: 010200370
VISIT DATE: 08/24/2021
NARRATIVE
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All required forms are posted. The last disaster drill was completed on 8/19/21. The facility is equipped with first aid supplies, a working telephone, working carbon monoxide detectors, smoke detectors, pull down fire alarms and fully charged 3A40BC fire extinguishers. LPM observed the interaction between the staff and children in care, and found it to be in compliance with the Title 22 Regulations.

The facility has a sign in/out sheet and LPM observed that 9 children are signed in. LPM reviewed children's and staff files. Children's files reviewed have completed emergency information forms and medical assessment. At 12:25pm LPM reviewed staff files and found that 2/2 files were missing the proof of completion of the mandated reporter training and proof of immunization for measles, pertussis and influenza. The facility is in ratio, and compliant with the capacity of the license today.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated 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)/ (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. The director confirmed that there are no children currently enrolled that require medication to be provided while in care.

The director was reminded to review information related to applicable regulations on Licensing's website at www.ccld.ca.gov. LPM reminded the director to adhere to all requirements within the regulations at all times including supervision, personal rights, unusual incident and injury reporting, and criminal record clearance and association requirements. The director was encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. LPM reminded the licensee that the mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

See 809D for deficiencies being cited today. This report shall remain on file for 3 years. A Notice of Site Visit was provided and must remain posted for 30 days. An exit interview was conducted and appeal rights were provided.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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Document Has Been Signed on 08/24/2021 02:40 PM - It Cannot Be Edited


Created By: Loretta Dyson On 08/24/2021 at 01:45 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: LAKESHORE CHILDREN'S CENTER

FACILITY NUMBER: 010200370

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 08/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/24/2021
Section Cited
HSC
1596.8662a(4)b(1)

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date
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The director agreed that staff will provide proof of completion of both the general and child care components of the mandated reporter training, to Licensing by 9/24/21. The director advised that she understands this needs to be completed by all staff and renewed every 2 years.
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on which he or she completed the initial mandated reporter training.
This requirement has not been met as evidenced by a review of staff files, and observation that 0/2 staff have proof of completion of the training. This poses a potential risk to the health and safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
Type B
09/24/2021
Section Cited
HSC1596.7995(a)(1)

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Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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The director agreed to provide proof of the required immunizations for all staff to Licensing by 9/24/21. The director understands that staff can decline the flu shot with a written and signed statement.
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This requirement has not been met as evidenced by a review of staff files, and observation that 0/2 staff have proof of the required immunizations. This poses a potential risk to the health and safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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
LICENSING EVALUATOR NAME:Loretta Dyson
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2021


LIC809 (FAS) - (06/04)
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