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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010210116
Report Date: 07/16/2021
Date Signed: 07/16/2021 11:14:10 AM

Document Has Been Signed on 07/16/2021 11:14 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:LLESA CHILDREN'S CENTERFACILITY NUMBER:
010210116
ADMINISTRATOR:REBECCA HESTERFACILITY TYPE:
850
ADDRESS:1399 ALMOND AVENUETELEPHONE:
(925) 424-0507
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 100TOTAL ENROLLED CHILDREN: 100CENSUS: 24DATE:
07/16/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monique Robles and Margie CastelloTIME COMPLETED:
11:30 AM
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 07/16/2021 Licensing Program Analyst (LPA) Jaylena Miller met with Monique Robles (Pre-school program director) and Margie Costello (Infant/Toddler Program director), for the purpose of a Unannounced Case Management Visit. The facility self reported on 06/18/2021 and a copy of the Unusual Incident Report (UIR) was reviewed by LPA. Per the report, A staff members failed to make sure that all children were accounted for when parent of C1 came to pick her up she was standing outside the classroom unsupervised. Per UIR C1 was outside the classroom unsupervised for 2-3 minutes. As a result, there was an Absence of Supervision, one child was left outside classroom without supervision. Although the facility states that the child was left outside alone for two – three minutes, Title 22 Regulations, 101229(a)(1) states that no child(ren) shall be left without the supervision of a teacher at any time including visual supervision.

The facility will be cited a Type A citation and charged an immediate civil penalty of $500 for the Absence of Supervision.

The facility must post this report for thirty days. The facility must give each parent of the children in care and future parents of newly enrolled children, for the next one year, a copy of this report. Parents are to sign an LIC 9224- Acknowledgment of Receipt of Licensing reports and this form shall be placed in each child's file. Failure to post report and or provide a copy of this report to parent's/authorized guardians can result in additional monetary assessments to the facility.

This report must remain on file for three years. The Program Directors were provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The facility was advised that due to the serious nature of this incident, a Non Compliance Conference with Community Care Licensing Management may be required to discuss the Unusual Incident.

Notice of site visit was provided and must be posted for 30 days. Exit interview conducted with Program Directors Monique and Margie.

Please see LIC 809-D Type A Deficiency
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2021
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 07/16/2021 11:14 AM - It Cannot Be Edited


Created By: Jaylena Miller On 07/16/2021 at 10:57 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: LLESA CHILDREN'S CENTER
FACILITY NUMBER: 010210116

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/16/2021
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION 101229(a)(1)
(a)The licensee shall provide care and supervision… No child(ren) shall be left without the supervision of a teacher at any time except as specified… Supervision shall include visual observation. This requirement was not met as evidence by:
1
2
3
4
5
6
7
The facility will submit a Plan of Correction in writing by indicating how they will ensure that children are always directly supervised . The facility will also have a training with staff about the importance of supervision. Staff will also watch a video on Supervision on CCLD website. A copy of the summary of the training and a roster of staff who attended the training will be sent to LPA by 7/19/2021 end of day.
8
9
10
11
12
13
14
Based on observation, interview and record review the facility did not ensure all children were accounted for during pick and C1 was outside classroom unsupervised for 2-3 minutes which poses an immediate risk to the health and safety of children in care.
8
9
10
11
12
13
14
The facility will receive a Civil Penalty Assessment in the amount of $500.

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:Wynn Norona
LICENSING EVALUATOR NAME:Jaylena Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 07/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2021


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