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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418997
Report Date: 03/06/2025
Date Signed: 03/06/2025 01:41:25 PM

Document Has Been Signed on 03/06/2025 01:41 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:OUSD - ALLENDALE PRESCHOOLFACILITY NUMBER:
013418997
ADMINISTRATOR/
DIRECTOR:		HERRERA, CHRISTIEFACILITY TYPE:
850
ADDRESS:3670 PENNIMAN AVE.TELEPHONE:
(510) 879-1010
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 17DATE:
03/06/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Tarya WhiteTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
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On 3/6/25, at 8:45am, Licensing Program Analyst (LPA) Catherine Fernandes arrived to conduct a Case Management- deficiencies and met with head teacher Tarya White. Shortly after Sara Farmer, Network Partner arrived. There were 17 children in care and an additional three staff members.

Upon arrival LPA Fernandes observed that the license states there are three approved waivers that need to be posted with the license, no waivers are posted and when asked for the waivers staff was unaware of any waivers.

While at the center LPA Fernandes requested staff files to review and Sara Farmer stated there is an agreement with our office and the regional manager that says they do not need to provide staff files to licensing and that they are not available due to them being at a another location. Farmer also added the staff do not have a current CPR certificate.

LPA Fernandes provided a copy of the personal rights regulations and reminded the center the importance of reporting requirements.

See 809D for the deficiencies cited during todays inspection

A notice of site was provided and needs to be posted for 30 days.

Exit interview conducted, report reviewed with Teacher Tarya White and Sara Farmer.
Report, Appeal Rights and Notice of Site visit provided
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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 03/06/2025 01:41 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 03/06/2025 at 09:29 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: OUSD - ALLENDALE PRESCHOOL
FACILITY NUMBER: 013418997

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2025
Section Cited
CCR
101217(c)

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Personnel- All personnel records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. This requirement was not met as evidenced by:
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Center will come up with a plan to ensure that upon request records will be available for licensing to review then send the plan to CCL by POC date.
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Based on a conversation with Sara Farmer the records were not avaiable be brought to the center for review based on an agreement with Licensing, which is a potential safety risk to children in care.
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Type B
03/27/2025
Section Cited
CCR101217(b)(A)

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Waivers and Exceptions for Program Flexibility-The licensee shall maintain and make available for review, at the child care center, a copy of the written approval or denial. This requirement has not been met as evidenced by:
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Center will review and post the waivers as agreed upon then send proof of postings to CCL by POC date.
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Based on LPA's observations no waivers were posted and when asked for the waivers staff was unaware of any waivers, which is a potential safety risk 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:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/06/2025 01:41 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 03/06/2025 at 01:37 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: OUSD - ALLENDALE PRESCHOOL
FACILITY NUMBER: 013418997

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/27/2025
Section Cited
CCR
101216(f)

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Personnel Requirements- At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement has not
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The center will schedule a training to bring the center back into compliance then send the date of the training to CCL by POC date.
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been met as evidenced by: Based on conformation from Sara Farmer no staff have a current CPR which is a potential safety risk 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:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
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