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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214911
Report Date: 09/14/2023
Date Signed: 09/14/2023 12:54:17 PM

Document Has Been Signed on 09/14/2023 12:54 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:KIDANGO-DELAINE EASTIN CHILD DEV. CENTERFACILITY NUMBER:
010214911
ADMINISTRATOR:HARDY, PETERFACILITY TYPE:
850
ADDRESS:584 BROWN ROADTELEPHONE:
(510) 490-5570
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 15DATE:
09/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Peter HardyTIME COMPLETED:
01:00 PM
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On 09/14/2023, Licensing Program Analyst (LPA) Melanie Otsuji conducted an unannounced Case Management Visit - Incident inspection. LPA met with Director, Peter Hardy and explained the nature of the visit. Also present during this visit were 3 staff members and 15 preschool aged children. A health and safety inspection was conducted.

On 08/08/2023, the Director reported an Unusual Incident to the Regional Office (RO). The summary of the unusual incident is as follows;
Children were out on the play yard and were all transitioning inside to get ready for lunch. To have them get ready for lunch S1 had the children run laps around the play structure. When C1 and C2 were not seen, S1 called out to them and started to walk towards them. C2 informed S1 that C2 was bitten by C1. Parents of both C1 and C2 were informed of the incident. New facility policy specifies that there must be a minimum of two staff members both inside and outside at any time during transition time.

No deficiencies cited on today's date. A notice of site visit was given and must remain posted for 30 days.

Exit Interview conducted and report was reviewed with the Director Peter Hardy.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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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