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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416837
Report Date: 09/04/2024
Date Signed: 09/04/2024 01:59:50 PM

Document Has Been Signed on 09/04/2024 01:59 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:
013416837
ADMINISTRATOR/
DIRECTOR:		GUADALUPE LARA-CEJAFACILITY TYPE:
830
ADDRESS:2500 MOWRY AVENUETELEPHONE:
(510) 996-5738
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 16DATE:
09/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:25 AM
MET WITH:Guadalupe Lara-CejaTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
NARRATIVE
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On September 4th, 2024, at approximately 11:25am, Licensing Program Analyst (LPA) April Wright met with Center Director Guadalupe Lara-Ceja for a Case Management visit. Present were sixteen (16) children (6 infants/10 toddlers) and 7 fingerprint cleared staff personnel. The purpose of the visit was to follow up on unusual incident report received and submitted by the facility regarding a personal rights violation.

On 8/27/2024, C1 feel asleep on the playground during play time and S1 noticed the child sleeping the in bungalow. S1 went to get C1, woke them up and "splashed" water on their face to wake them up. S2 witnessed the incident and stated to S1, "this isn't right and we can't do this to children", per the incident report received.

During interview/meeting with S1 they stated to the LPA, S3 and S4 that, "I did put water on C1 face with my hand because it was hot, but I did not splash water on C1 face". S3 translated conversation in Spanish with S2 due to language barrier and understanding of English Language. S1 also stated that they feel the other staff including S2, have "something against me" and "don't like me, because this is why they say these things about me, it's not fair".

LPA was present while S3 and S4 met with S1 to advise of the incident and further steps the facility would be taking as of today.

As a result of the admission and incident that occurred, S1 was placed on administrative leave by Kidango Human Resources effective immediately while an internal investigation is conducted. Plan of Correction for facility will be to revisit CCLD Video regarding personal rights of the child and submit proof to LPA by due date given on LIC809D.


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: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
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 09/04/2024 01:59 PM - It Cannot Be Edited


Created By: April Wright On 09/04/2024 at 11:44 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: 013416837

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2024
Section Cited
CCR
101223(a)(1)(3)

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Personal Rights 101223 (a)(1)(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.
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Center director and Center Regional Director met with S1 and has been placed on administrative leave pending further investigation by HR. Center Director. Revisit the Personal Rights video and send proof to LPA by 9/9/20204.
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This was evidenced by: By admission, S1 admitted to have splashed water in the child face to wake them up, which posed an potential risk to the health, safety, or personal rights to 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:Chandra Charles
LICENSING EVALUATOR NAME:April Wright
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024


LIC809 (FAS) - (06/04)
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