<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010200370
Report Date: 09/27/2023
Date Signed: 09/27/2023 11:41:07 AM

Document Has Been Signed on 09/27/2023 11:41 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: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: 49CENSUS: 7DATE:
09/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Teresita Arciaga/ Elmo Rey Arciaga TIME COMPLETED:
12:00 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 09/27/2023 at 9:15 AM Licensing Program Analyst (LPA), A. Curry arrived at the facility to conduct an unannounced complaint inspection. LPA met with the Acting Director, Teresita Arciaga, to explain the purpose of today's visit. Upon arrival LPA observed 6 children alone in a classroom while staff member was in another classroom. The staff member did join the classroom with the children almost immediately after LPA arrived at the facility. During the visit, the LPA also observed the same staff leave the children alone in the classroom to retrieve an item from the refrigerator, which is located in another classroom. The staff immediately returned to the classroom with children. Both times, there were no other staff present. More staff did arrive later. The director was advised that staff must have visual supervision of each child at all times. Type B deficiency is being cited for lack of supervision (See 809D).

Exit interview conducted, appeal rights were given, and report was reviewed with Elmo Rey Arciaga.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 09/27/2023 11:41 AM - It Cannot Be Edited


Created By: Ashley Curry On 09/27/2023 at 10:22 AM
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: 09/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2023
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
101229 Responsibility for Providing Care and Supervision(a)The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time...
This requirement was not met as evidence by:
1
2
3
4
5
6
7
By 10/06/2023 submit a written statement on how the facility will never leave a child without supervision of a teacher. ex: Have more staff in the morning.
8
9
10
11
12
13
14
LPA observed the children in the classroom alone, while staff was in another classroom on two separate occasions, which is a potential risk to the health, safety, and personal risk to the children in care. Both times, the staff immediately returned to the classroom.
8
9
10
11
12
13
14

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
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:Loretta Dyson
LICENSING EVALUATOR NAME:Ashley Curry
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023


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