<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421295
Report Date: 02/06/2023
Date Signed: 02/06/2023 03:39:29 PM

Document Has Been Signed on 02/06/2023 03:39 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:MCDONALD, ERICKAFACILITY NUMBER:
013421295
ADMINISTRATOR:MCDONALD, ERICKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 926-8050
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
02/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Ericka McDonaldTIME COMPLETED:
03:16 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 2/6/2023 Licensing Program Analyst (LPA) Morgan Pringle met with Licensee Ericka McDonald for an Unannounced Case Management visit. Present during the visit was the Licensee, two (2) infants and two (2) preschool age children. An unusual incident report was made by the Licensee 1/24/2023.

Licensee stated that the incident happened on 1/19/2023 during pickup time were a child in care was limping when their mother came to pick them up. Licensee stated that the child's mother took the child to the doctors on 1/20/2023, where it was found on 1/23/2023, that the child had a fracture on the bottom of their foot. The child returned to care the next day but was disenrolled on 1/25/2023. Licensee stated that the child appeared physically fine during care. Licensee stated there was no medical record provided to state that the child sustained a fracture.

No deficiencies were cited during this visit for this incident.

Notice of site visit was provided and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Ericka McDonald
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1