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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415231
Report Date: 05/08/2024
Date Signed: 05/08/2024 11:37:58 AM

Document Has Been Signed on 05/08/2024 11:37 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KIDANGO-DECOTOFACILITY NUMBER:
013415231
ADMINISTRATOR/
DIRECTOR:		GARCIA, CATALINAFACILITY TYPE:
850
ADDRESS:600 G STREETTELEPHONE:
(510) 675-7101
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 38DATE:
05/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Catalina Garcia- DirectorTIME VISIT/
INSPECTION COMPLETED:
11:45 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 5/8/24 at 10:40am, Licensing Program Analyst (LPA) Briana Plumboy conducted a Case Management visit following an Unusual incident that occurred on 5/2/24. Present for the inspection was 8 staff and 38 preschool age children. Director self reported the incident on 5/3/24. LPA conducted a staff interview.

LPA Plumboy spoke with the facility Director Catalina Garcia about the incident that happened on 5/2/24. The representative stated a staff member grabbed child from the left arm and took him to the play dough table forcing child to walk and sit. The child was crying and refusing. The staff member has and is continuously received training since the incident and is being trained and supervised by a "Master Teacher."

Based on the Unusual Incident report and the staff interview, the facility is being cited for a violation of the child's Personal Rights.
CCR 101223 (a)(3) Personal Rights

See 809-D for deficiency which must be corrected by the Plan of Correction
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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 05/08/2024 11:37 AM - It Cannot Be Edited


Created By: Briana Plumboy On 05/08/2024 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: KIDANGO-DECOTO
FACILITY NUMBER: 013415231

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2024
Section Cited
CCR
101223(a)(3)

1
2
3
4
5
6
7
Personal Rights 101223 (a)(3) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons. (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
1
2
3
4
5
6
7
The staff member will watch the "Personal Rights video in Child Care Centers" on the CCLD website. The facility representaive will have the staff sign and date a written statement
8
9
10
11
12
13
14
This requirement was not met as evidenced by: a staff member grabbed a child from the left arm and took him to the play dough table forcing child to walk and sit which posed a potential risk to the health, safety, or personal rights to persons in care.
8
9
10
11
12
13
14
acknowledging that they have watched the assigned training video and understand their responsibility to provide Personal Rights to children at all times. The facility representative will email this signed statement to LPA Plumboy no later than 5/10/2024 at 5:00 PM.

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:Briana Plumboy
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024


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