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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418973
Report Date: 02/21/2024
Date Signed: 02/21/2024 01:07:39 PM

Document Has Been Signed on 02/21/2024 01:07 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LEARNING TREE, THEFACILITY NUMBER:
013418973
ADMINISTRATOR:COLGAN, JENNAFACILITY TYPE:
850
ADDRESS:34050 PASEO PADRE PKWYTELEPHONE:
(510) 791-6161
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 104TOTAL ENROLLED CHILDREN: 104CENSUS: 34DATE:
02/21/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Katelyn KellyTIME COMPLETED:
01:10 PM
NARRATIVE
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On 02/21/2024 Licensing Program Analyst (LPA) Jaleesa Jackson conducted an unannounced case management deficiencies visit. LPA met with Assistant Director Katelyn Kelly. Present for the inspection were 8 staff and 34 preschool age children and 3 toddlers in care.

At 10:20AM LPA toured the facility with the Assistant Director. LPA observed a volunteer with 7 children without a fully qualified teacher in the room. LPA informed Assistant Director that all volunteers need to be under the direct supervision of fully qualified teacher and can not be with them alone. The director immediately placed a qualified teacher in the room with the volunteer.

See 809-D for deficiencies cited during today's inspection.

Director was informed of this on report dated 02/21/2024 that copies need to be provided to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 Acknowledgement of Receipt of Licensing Reports should be signed by guardians and placed in each child’s file.

Exit interview conducted with Assistant Director Katelyn Kelly and appeal rights provided.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2024
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 02/21/2024 01:07 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 02/21/2024 at 12:39 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: LEARNING TREE, THE
FACILITY NUMBER: 013418973

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/22/2024
Section Cited
HSC
1596.871(b)(1)(D)(i)

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A volunteer providing time-limited specialized services shall be exempt from the requirements of this subdivision if this person is directly supervised by the licensee or a facility employee with a criminal record clearance... the volunteer is not left alone with children in care.
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The Director immediately placed a staff member in the room with the volunteer.
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This requirement is not met as evidenced by:
Based on interview and record review, the licensee did not comply with the section cited above as the facility did not report an usual incident where a child required medical treatment.
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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:Jason Jang
LICENSING EVALUATOR NAME:Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024


LIC809 (FAS) - (06/04)
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