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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422003
Report Date: 05/08/2024
Date Signed: 05/08/2024 10:58:17 AM

Document Has Been Signed on 05/08/2024 10:58 AM - 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:OUSD - UNITED NATION CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013422003
ADMINISTRATOR/
DIRECTOR:		MANSKER, ANNAFACILITY TYPE:
850
ADDRESS:1025 - 4TH AVETELEPHONE:
(510) 273-1616
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY: 168TOTAL ENROLLED CHILDREN: 168CENSUS: DATE:
05/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Lilly SienTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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On 05/08/2024 at 9:15 AM Licensing Program Analyst (LPA), A. Curry arrived at the facility to follow up on a self-reported unusual incident where a substitute teacher handled a child inappropriately. LPA met with teacher in charge, Lilly Sien, to explain the purpose of today's visit. LPA toured the facility, retrieved documentation, and conducted interviews. The interviews revealed that the substitute teacher forcefully grabbed a child, which left a mark on the child's arm. ( See 809D for deficiency that was cited today)

LPA A. Curry informed facility representative Lilly Sien that this report dated 05/08/2024 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA A. Curry informed the facility representative Lilly Sien to provide a copy of this licensing report dated 05/08/2024 that documents any Type A citation(s) 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 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


Exit interview conducted, appeal rights were given, and report was reviewed with teacher in charge, Lilly Sien.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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 05/08/2024 10:58 AM - It Cannot Be Edited


Created By: Ashley Curry On 05/08/2024 at 10:29 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 - UNITED NATION CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013422003

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2024
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights: (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...
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Immediate POC cleared by visit due to facility terminating substitute teacher's employment.

Please see below for 2nd POC due date.
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This requirement is met as evidence by:
Based on interviews the licensee did not comply with the section cited above by ensuring staff are not handling day care children inappropriately, which poses an immediate risk.
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By 05/31/2024 the facility will conduct an all staff training on Personal Rights. The Site Principal will email LPA the attendance sheet for staff who attended the training.

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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:Ashley Curry
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024


LIC809 (FAS) - (06/04)
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