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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416836
Report Date: 10/27/2023
Date Signed: 10/27/2023 12:01:02 PM

Document Has Been Signed on 10/27/2023 12:01 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KIDANGO - WASHINGTON HOSPITAL CENTERFACILITY NUMBER:
013416836
ADMINISTRATOR:TAMIKA COOKSFACILITY TYPE:
850
ADDRESS:2500 MOWRY AVENUETELEPHONE:
(510) 996-5738
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 20DATE:
10/27/2023
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Guadalupe Lara-CejaTIME COMPLETED:
12:00 PM
NARRATIVE
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On October 27th, 2023 at approximately 9:25am, Licensing Program Analyst (LPA) April Wright conducted a Case Management visit and met with Center Director Guadalupe Lara-Ceja. Present today were 20 preschool age children and 7 staff personnel. The purpose of today's visit is to follow up to an unusual incident report submitted by the facility regarding a lack of supervision incident with a day care child.

Per the incident report received via phone, "On October 18th, 2023 around 10am, The center was conducting a practice fire drill. Arya wasn't feeling well so she was laying on the playground bench. Staff realized Arya was missing due to headcount (less than 10 minutes) and rushed back downstairs. Teacher went outside and Arya was still sleeping on bench and was brought her back in."

LPA had Center Director Lara-Ceja show the fire drill evacuation route. Center is located on the 3rd floor of Washington Hospital where staff and children must exit the building via the outside staircase to the ground floor and meet in the rear of the hospital building. LPA also interviewed staff members that witnessed the incident.

Due to the lack of supervision during this incident, the facility is being issued a Type A Violation today and a $500.00 civil penalty is also being assessed. LPA informed Center Director that this report dated 10/27/2023 which documents one Type A citation which shall be posted for 30 consecutive days. This violation posed an immediate risk to the health, safety, or personal rights of children in care.



LPA also informed the center director to provide a copy of this licensing report dated 10/27/2023 that documents a 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.

Notice of site visit was given and must remain posted for 30 days. Report read and appeal rights given to Center Director Guadalupe Lara-Ceja.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2023
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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Document Has Been Signed on 10/27/2023 12:01 PM - It Cannot Be Edited


Created By: April Wright On 10/27/2023 at 10:27 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 - WASHINGTON HOSPITAL CENTER
FACILITY NUMBER: 013416836

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/27/2023
Section Cited
CCR
101229(a)(1)

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ZERO TOLERANCE - Responsibility for Providing Care and Supervision: (a)The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time,
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Center Director will have staff meeting and training to remind staff of duties and responsibilities of supervising children, during disaster drills and classroom supervision.
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Based on interviews and record review, the center did not comply with the section cited above in which child was left alone unsupervised during a fire drill, which poses an immediate health, safety or personal rights risk to children in care. A zero tolerance deficiency is being issued
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Staff will also watch the "Supervising Children in Child Care Centers" on the CCLD website. Staff will write a statement of understanding and submit to LP by 10/31/23.

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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:Chandra Charles
LICENSING EVALUATOR NAME:April Wright
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2023


LIC809 (FAS) - (06/04)
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