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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206137
Report Date: 02/18/2025
Date Signed: 02/18/2025 04:43:52 PM

Document Has Been Signed on 02/18/2025 04:43 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:OUSD - HARRIET TUBMANFACILITY NUMBER:
010206137
ADMINISTRATOR/
DIRECTOR:		REED, VONZELEFACILITY TYPE:
850
ADDRESS:800-33RD STREETTELEPHONE:
(510) 654-7890
CITY:OAKLANDSTATE: CAZIP CODE:
94608
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 21DATE:
02/18/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Caroline JonesTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On February 18, 2025 at 9:00am, Licensing Program Analysts (LPAs) Indira Loza and Dana Santiago arrived at the facility for an unannounced Annual/Random inspection. LPAs met with Site Administrator Lawrence Gotanco and Director for Early Childhood for the Oakland Unified School District (OUSD) Caroline Jones. Present during today's inspection were 21 children and 8 staff. The teacher/child ratio was being met today. The center was toured for a health and safety check. This center operates Monday through Friday 8am to 5pm.

CLASSROOMS: The preschool operates out of three classrooms. There is adequate heating/air conditioning, ventilation, and lighting. There were no cleaning supplies or toxic items accessible to children. The toys appear to be safe and well maintained. There were play and learning materials available for the children and each classroom had plenty of age appropriate activities. The furniture and equipment are age appropriate and in good repair. There is proper individual storage space for each child. The center is equipped with hardwired smoke detectors throughout the facility, a plug-in carbon monoxide detector located in the kitchen, telephone, and pull down fire alarm system - all were in working order. There is a fully charged 2A10BC fire extinguisher outside the front office.

FOOD SERVICE AREAS: The center provides Breakfast, Lunch, and one afternoon snack to the children. There are menus posted. Water is provided to the children from water jugs which are filled with water from a Flowater dispenser.

OUTDOOR PLAY AREAS: The play yard is fully fenced in and has plenty of age appropriate activities and shade for the children in care. There is space for the children to run and develop their gross motor skills. There are no bodies of water, swimming pools, or wading pools on the daycare premises. The play structures were anchored and had cushioning material underneath to absorb any falls.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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: OUSD - HARRIET TUBMAN
FACILITY NUMBER: 010206137
VISIT DATE: 02/18/2025
NARRATIVE
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BATHROOMS: The center has separate bathrooms designated for staff and children. There are six (6) Toilets and four (4) faucets available for the children to use, they are appropriately sized for the children, and all are in safe, sanitary, and operating condition.

RECORDS: LPAs reviewed 5 children files and 7 staff files. All children files reviewed were complete. The staff files were all missing the staff's immunization records, TB clearance, Personnel Record, and Medical Report. All individuals subject to criminal record review have a criminal record clearance. All required documents are posted for public review. There are multiple staff members with current CPR certification during all hours of the day. A physical census of the children was taken and cross referenced with the sign-in and out log. All children were accounted for and properly signed in. The last Fire drill was conducted on December 2023.

Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone or fax. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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.

Director 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.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
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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: OUSD - HARRIET TUBMAN
FACILITY NUMBER: 010206137
VISIT DATE: 02/18/2025
NARRATIVE
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This facility is currently providing Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information seePIN 22-02-CCP 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/.

Director 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
CCC COMPLETED TESTING AND IS IN THE PROCESS OF REMEDIATING EXCEEDANCES. LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

See LIC809-D for 3 Type B citations

Exit interview conducted.
Report and appeal rights was reviewed with Director for Early Childhood for the OUSD, Caroline Jones.
Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025
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Document Has Been Signed on 02/18/2025 04:43 PM - It Cannot Be Edited


Created By: Indira Loza On 02/18/2025 at 03:37 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: OUSD - HARRIET TUBMAN
FACILITY NUMBER: 010206137

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239.2(a)
Drinking Water
(a) Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in The facility was cited in January 2024 due to faucets F, K, and P exceeding the requirements for lead. This which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
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The facility shall either permanently remove the faucet or have it remediated and re-tested. Proof of this shall be emailed to LPA no later than February 28, 2025.
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 7 out of 7 staff files reviews were missing the staff's immunization, TB clearances, Personnel Report, and Health Screening which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
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The Director shall send the LPA a copy of all the staff immunization, TB clearances, Personnel Report, and Health Screening. These documents o \r provide the waiver that was mentioned during the inspection, no llater than February 28, 2025.
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:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2025


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Document Has Been Signed on 02/18/2025 04:43 PM - It Cannot Be Edited


Created By: Indira Loza On 02/18/2025 at 03:57 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: OUSD - HARRIET TUBMAN
FACILITY NUMBER: 010206137

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on interview and record review, the licensee did not comply with the section cited above as the last fire drill was conducted on December 2023 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
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The facility shall conduct and record a disaster drill and send the LPA a photo of the updated drill log.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2025


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Document Has Been Signed on 02/18/2025 04:43 PM - It Cannot Be Edited


Created By: Indira Loza On 02/18/2025 at 04:11 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: OUSD - HARRIET TUBMAN
FACILITY NUMBER: 010206137

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(3)(B)
Health-Related Services (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as multiple children were missing the Parent Consent for Administered Medication and the Nebulizer Care/Consent Verification form, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/28/2025
Plan of Correction
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The facility Representative shall send the LPA a signed Parent Consent for Administered Medication and the Nebulizer Care/Consent Verification form for all children who receive medication.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2025


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