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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206027
Report Date: 04/02/2021
Date Signed: 04/02/2021 12:55:40 PM

Document Has Been Signed on 04/02/2021 12:55 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:ST. VINCENT'S DAY HOMEFACILITY NUMBER:
010206027
ADMINISTRATOR:YOUNGBLOOD, JENNIFERFACILITY TYPE:
850
ADDRESS:1086 8TH STREETTELEPHONE:
(510) 832-8324
CITY:OAKLANDSTATE: CAZIP CODE:
94607
CAPACITY: 261TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
04/02/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Kira LewisTIME COMPLETED:
01:30 PM
NARRATIVE
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On 04/02/2021, Licensing Program Analyst (LPA) Brittany Newton conducted an unannounced visit for the purpose of following up on an incident that occurred on 03/19/2021 regarding a child leaving the classroom and being on the staircase. LPA was met by director Kira Lewis, assistant director of administration Natalie Cone, and Carmen Baires family services director. Present for the inspection was 69 preschoolers. LPA Newton interviewed teachers on site regarding the incident.


Interviews and documentation reviewed confirmed that a child was able to leave the classroom due to only one teacher being in the classroom as the other teacher was using the restroom.

Facility is being cited one type B citation for providing care and supervision.

Please see attached report for the citation being cited. Facility given Notice of Site visit which must remain posted for 30 days. A copy of this report was left and appeal rights were provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Brittany Newton
LICENSING EVALUATOR SIGNATURE: DATE: 04/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/02/2021
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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Document Has Been Signed on 04/02/2021 12:55 PM - It Cannot Be Edited


Created By: Brittany Newton On 04/02/2021 at 12:27 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: ST. VINCENT'S DAY HOME
FACILITY NUMBER: 010206027

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/09/2021
Section Cited
CCR
101229(a)(1)

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101229(a)(1) 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, (1). Supervision shall include visual observation.
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Facility will send LPA Newton a supervision plan that will be discussed with staff. Signatures should be obtained for all staff that go over the training and the copy of the plan should be sent to LPA Newton by 04/09/2021.

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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:Brittany Newton
LICENSING EVALUATOR SIGNATURE:
DATE: 04/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/02/2021


LIC809 (FAS) - (06/04)
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