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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422003
Report Date: 02/14/2025
Date Signed: 02/14/2025 02:20:17 PM

Document Has Been Signed on 02/14/2025 02:20 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 - 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: 81DATE:
02/14/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:HEREDIA, MIRSHATIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On February 14, 2025, at 12:05PM Licensing Program Analyst (LPA) Nyeesha Blount conducted an unannounced case management visit regarding an unusual incident reported to the Oakland Regional Office on January 28, 2025. LPA met with Site Supervisor Mirsha Heredia.

LPA toured the center for a Health and Safety check and interviewed the Site Supervisor about the incident that occurred.

Type A deficiencies were cited during today's visit. See LIC809D. Exit interview conducted.

A copy of the report and appeal rights provided to Site Supervisor Mirsha Heredia.
Notice of Site Visit provided.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Nyeesha Blount
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
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 2
Document Has Been Signed on 02/14/2025 02:20 PM - It Cannot Be Edited


Created By: Nyeesha Blount On 02/14/2025 at 01:03 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 - UNITED NATION CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013422003

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/14/2025
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care & Supervision (a) [..] provide care and supervision [..]meet the children's needs (1) No child(ren) shall be left without the supervision [..] include visual observation. This requirement is not met as evidenced by:
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By POC Facility will submit a written plan of action on how facility will ensure full supervision at all times and understanding Licensing Regulation for Providing Care and Supervison.
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Based on record review and interviews Child was seen left unattended on the patio between classroom 5 and 6, which poses an immediate health, safety or personal rights risk to persons in care.
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By 02/19/25 close of business. All staff will have meeting/training watching video on Supervision on CCLD website will be reviewed by all. Site Supervisor will submit proof of staff meeting to LPA.

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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:Nyeesha Blount
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2025


LIC809 (FAS) - (06/04)
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