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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420589
Report Date: 06/19/2024
Date Signed: 06/19/2024 05:42:48 PM

Document Has Been Signed on 06/19/2024 05:42 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:ALAMEDA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013420589
ADMINISTRATOR/
DIRECTOR:		HUNT, VIRGINIAFACILITY TYPE:
850
ADDRESS:500 PACIFIC AVENUETELEPHONE:
(510) 748-4001
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 27DATE:
06/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Jill HunterTIME VISIT/
INSPECTION COMPLETED:
05:45 PM
NARRATIVE
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On 6/19/24 at 2:45pm, Licensing Program Analysts (LPAs) Catherine Fernandes and Mario Caro arrived unannounced on a case management inspection due to an incident that was self reported to Community Care Licensing and met with Director Jill Hunter.

There was an incident on June 14, 2024, where a parent observed a child alone near the bathroom which is right outside of the main outdoor play area. The staff was unaware the child was gone until the parent brought the child back to the main playground.
There will be a Type A citation issued for the incident. LPAs informed Director Hunter to post and provide a copy of this licensing report dated 6/19/24 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 next 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224) must be placed in the child's file for verification.

While at the center LPAs observed the toddler classes using classroom 14 which is a licensed classroom for Licensed 013421427. The toddler classroom is using room 14 as a temporary classroom while the school is having construction done. Moving forward the director is going to write up a plan, provide dates for the construction, and submit LIC200A along with a facility sketch.

See 809D for citation.

Exit Interview conducted.
Report and Appeal Rights reviewed and provided to Director
The Notice of Site Visit must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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 06/19/2024 05:42 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 06/19/2024 at 04:02 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: ALAMEDA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013420589

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/20/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision- No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement has not
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The center will provide an outside training for all staff members and send a plan of improvement, the dates for training, and the outside trainers to CCL by POC.
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been met as evidence by: Based on interviews and a recent incident report a child was left with no supervision which is an immediate risks 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: 06/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2024


LIC809 (FAS) - (06/04)
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