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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206151
Report Date: 10/14/2022
Date Signed: 10/14/2022 04:47:56 PM

Document Has Been Signed on 10/14/2022 04:47 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 - JEFFERSONFACILITY NUMBER:
010206151
ADMINISTRATOR:GRIFFIN, ANASTASIAFACILITY TYPE:
850
ADDRESS:1975 - 40TH AVENUETELEPHONE:
(510) 436-3700
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 15DATE:
10/14/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Anastasia GriffinTIME COMPLETED:
05:00 PM
NARRATIVE
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LPA Dyer conducted a Case Management - Deficiencies inspection. LPA met with Head Teacher Anastasia Griffin. Present at the facility: head teacher, 2 additional teachers, 3 aids, and 15 preschool children. During the course of a complaint investigation, it was determined that a child has climbed onto the retaining wall at the facility, over the center fence, and left the facility. It is also possible for children to climb under the facility fence, as well, and exit the facility. Children have also left the facility and went into the yard through the bathrooms and classroom without supervision.

The attached type A deficiency is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Exit interview conducted. Licensee was provided copy of their appeal rights. This report must be kept available for public review for 3 years.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 10/14/2022 04:47 PM - It Cannot Be Edited


Created By: Phyllis Dyer On 10/14/2022 at 03:34 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 - JEFFERSON
FACILITY NUMBER: 010206151

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/17/2022
Section Cited
CCR
101238(a)

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Buildings and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times. CHILDREN ARE ABLE TO CLIMB OVER AND UNDER FACILITY FENCES AND EXIT THE CENTER DUE TO THE FENCE SIZE/CONFIGURATION; AND OPEN DOORS EXITING FACILITY.
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Facility will need to re-evaluate how children will play in the yard, making sure that they are not able to exit the fences; and how they will not be able to exit into the yard. Facility will also need to provide a plan as to when the fences will be replaced or repaired.
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This requirement was not met as evidenced by staff interview and LPA observation: there are areas at the facility that are not safe where children can exit facility fences and exit into the yard. This poses an immediate Health and Safety risk to 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.

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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:Loretta Dyson
LICENSING EVALUATOR NAME:Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022


LIC809 (FAS) - (06/04)
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