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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010200370
Report Date: 06/21/2023
Date Signed: 06/21/2023 04:09:11 PM

Document Has Been Signed on 06/21/2023 04:09 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: 16CENSUS: 12DATE:
06/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Elmo Rey Arciaga TIME COMPLETED:
04:15 PM
NARRATIVE
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On 6/21/2023 at 9:15am, Licensing Program Analyst (LPA) Catherine Fernandes met with staff member Elmo Rey Arciaga for an Unannounced Required Annual Inspection. There were 12 preschool age children, with one additional staff member. There is a school age component attached to the license, 10212559. The center was toured for a health and safety inspection. The teacher child ratio was being met today. The facility operates from Monday through Friday from 8:00am–6:00pm.

The center operates out of the two homes, 3540 and 3546 Lakeshore avenue. The entrance to the preschool program are the gates between the two homes. During the inspection the center was only utilizing 3540 which has two classrooms. The upstairs area is not for children in care. The room floors, surfaces, furniture and equipment appear to be clean. The heating, lighting and ventilation is adequate. There is a total of two toilets, four sinks available for the children which are sanitary and in operational conditions. There are supplies available for the children to wash and dry their hands. There are separate bathrooms for staff in 3546. The activities appear to be age appropriate for the children in care. For napping the center is using napping cots. LPA did not observe any bodies of water, free standing water, cleaning supplies, or toxic items accessible to children during today’s inspection. The center prepares and provides snacks to the children while in care and lunches are brought from home. The kitchen area was maintained. There is a current menu posted for the month. The children have hooks to store personal belongings. All the children are using personal water bottles and access to drinking water. The classroom has a working carbon monoxide detector, a fire extinguisher and smoke detector.


All proper postings are made visible by the front of the center’s entrance. A physical census of the children and staff were taken and cross referenced with the sign-in and out log. All children were accounted for and properly signed in. LPA obtained the center’s facilities’ files and reviewed six children’s files and two staff files.

Report continued on 809C
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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: 06/21/2023
NARRATIVE
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The following deficiencies were cited during today's inspection.
- There is not a qualified director for center
-The center has not conducted their lead testing
- The fire/disaster drill log was not documented
- No staff members had the required training for mandated reporter
- There was no proof of CPR
- There is no roster to reflect the children in care
- Two out of six children did not have a completed medical assessment
- The is a cracked window that needs to be repaired

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

The center was reminded that all adults 18 and over, 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.

LPA referred the center to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

REPORT continues on 809C
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
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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: 06/21/2023
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

The center was informed of the MyChildCarePlan.org website; 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.

See 809D for deficiencies

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the center representative Elmo Rey Arciaga

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
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Document Has Been Signed on 06/21/2023 04:09 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 06/21/2023 at 02:43 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: 06/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)(2)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months. (2) The drills shall be documented. This documentation shall be kept in the child care center for at least one year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on interview, the center did not comply with the section cited above there are not documented disaster drills which poses a potential safety risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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The center will conduct a disaster drill and then document the drill on the form that was provided at the time of the inspection.
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the center did not comply with the section cited above there is a cracked window which posesa pontential safety risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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The window needs to be repaired send proof of correction to CCL POC date.
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 Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023


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Document Has Been Signed on 06/21/2023 04:09 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 06/21/2023 at 02:43 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: 06/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the center did not comply with the section cited above no lead testing has been conducted which poses a potential health rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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The center will provide proof of lead testing to CCL by POC date
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day 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 on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the center did not comply with the section cited above no mandated reporter training was completed which poses a potential personal rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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All staff members will complete the child care mandated reporter training and then send copies to CCL by POC date.
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 Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023


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Document Has Been Signed on 06/21/2023 04:09 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 06/21/2023 at 02:43 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: 06/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(b)
Child Care Center Director Qualifications and Duties
(b) All child care centers shall have a director.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the center did not comply with the section cited above there no quailied director which poses a potential risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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The center will sumbit documents for a qualifed Director to CCL by POC date.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the center did not comply with the section cited above no proof of CPR which poses a potential safety rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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Based on interview and record review, the center did not comply with the section cited above no proof of CPR which poses a potential safety rights risk to persons in care.
The center will provide proof of CPR training then send a copy to CCL by POC date.
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 Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/21/2023 04:09 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 06/21/2023 at 02:43 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: 06/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the center did not comply with the section cited above two out six children did not have an assessment which poses a potential health risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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3
4
The center review all files to ensure all forms are completed and signed and the send a statement of completion to CCL by POC date.
Type B
Section Cited
HSC
1596.841
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.

This requirement is not met as evidenced by:
Deficient Practice Statement
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3
4
Based on interview, the center did not comply with the section cited above there is no children's roster which poses a potential risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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3
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The center will complete a children's roster with all enrolled children then submit a copy to CCL by POC date.
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 Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023


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