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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010215033
Report Date: 10/16/2024
Date Signed: 10/16/2024 01:08:21 PM

Document Has Been Signed on 10/16/2024 01:08 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:OAKLAND HEAD START - MANZANITAFACILITY NUMBER:
010215033
ADMINISTRATOR/
DIRECTOR:		TERRY CHENFACILITY TYPE:
850
ADDRESS:2701 - 22ND AVENUETELEPHONE:
(510) 535-5627
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: DATE:
10/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:LaTonya RelifordTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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On 10/16/2024 at 11:45AM Licensing Program Analyst (LPA), A. Curry conducted an unannounced case management visit to follow up on a self-reported unusual incident where a child was able to slip through a small opening in the fence that surrounds the outdoor playground that leads to the street. LPA met with the designated facility Director, LaTonya Reliford, to explain the purpose of today's visit. LPA toured the facility and conducted interviews with staff. The interviews revealed that a child slipped through an opening in the fence and the child was on the other side of the fence for 5-10 seconds before a teacher realized the child was no longer on the playground. Although staff stated the child never left the other side of the fence, the playground was not properly fenced to ensure each child stays within the licensed outdoor activity space (See 809D). Since the incident occurred, the facility immediately installed additional fencing to block off access to the part of the fence that has an opening.

Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, appeal rights were given, and report was reviewed with the Director, LaTonya Reliford.


SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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 10/16/2024 01:08 PM - It Cannot Be Edited


Created By: Ashley Curry On 10/16/2024 at 12:44 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: OAKLAND HEAD START - MANZANITA
FACILITY NUMBER: 010215033

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/23/2024
Section Cited
CCR
101238.2(g)

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101238.2Outdoor Activity Space(g)The playground shall be enclosed by a fence to protect children and to keep them in the outdoor activity area. The fence shall be at least four feet high.

This requirement was not met as evidence by:
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The facility immediately installed an additional fence to prevent children from accessing the part of the fence that has an opening. LPA observed that the playground is properly fenced.

Cleared by visit.
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Based on observation and interviews the licensee did not comply with the above regulation, by ensuring the facility is properly fence and does not allow for children to leave the approved outdoor activity area, which poses a potential risk to the health, safety, and personal rights of children in care.
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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:Monica Mathur
LICENSING EVALUATOR NAME:Ashley Curry
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


LIC809 (FAS) - (06/04)
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