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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214911
Report Date: 01/16/2024
Date Signed: 01/16/2024 11:17:53 AM

Document Has Been Signed on 01/16/2024 11:17 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: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: 23DATE:
01/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Jessica WeimarTIME COMPLETED:
11:25 AM
NARRATIVE
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On 01/16/2024, Licensing Program Analyst (LPA) Melanie Otsuji conducted an unannounced Case Management Visit - Incident inspection. LPA met with Facility Representative, Jessica Weimar and explained the nature of the visit. Also present during this visit were 3 additional staff members and 23 preschool aged children. A health and safety inspection was conducted.

On 12/18/2023, the Director reported an Unusual Incident to the Regional Office (RO). The summary of the unusual incident is as follows;
S1 was in the play yard behind the building with a group of 7 children. S1 observed a child attempting to climb the fence and went to assist the child to get down safely. During this time C1 pushed open the gate separating the front play yard from the back play yard. C1's parent arrived at the time of the incident and escorted C1 into the facility to inquire why C1 was in the front play yard by themselves. Once S1 assisted the child down from the fence, S1 noticed C1 was not in the yard, S1 observed C1 in the classroom via the window. Based on the information received, a TYPE A deficiency is being cited on today's date, 1/16/2024 (see attached LIC809D).

LPA Otsuji informed facility representative, Jessica Weimar, that this report dated 1/16/2024 document(s) one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Otsuji informed the facility representative to provide a copy of this licensing report dated 1/16/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted where the citation and plan of correction were discussed. Appeal rights were given and explained to the facility representative, Jessica Weimar.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2024
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 01/16/2024 11:17 AM - It Cannot Be Edited


Created By: Melanie Otsuji On 01/16/2024 at 10:41 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: KIDANGO-DELAINE EASTIN CHILD DEV. CENTER
FACILITY NUMBER: 010214911

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/23/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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The facility representative will create a written statement with new protocols to follow to prevent a child in care from being left unattended. All staff will watch the "Supervising Children in Child Care Centers" on the CCLD website. The facility representative will have all staff sign and date the written statement
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This requirement is not being met as evidence by: C1 was able to open the gate separating the back play yard from the front play yard. C1 was in the front play yard when C1's parent arrived taking C1 inside. This poses an immediate risk to the health, safety, or personal rights to persons in care.
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acknowledging they have watched and understand the video. The facility representative will email this signed statement to LPA Otsuji no later than 1/23/2024.
https://ccld.childcarevideos.org/child-care-center-operators/supervising-children-in-child-care-centers/

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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:Wynn Norona
LICENSING EVALUATOR NAME:Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024


LIC809 (FAS) - (06/04)
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