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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422004
Report Date: 05/08/2024
Date Signed: 05/08/2024 02:47:12 PM

Document Has Been Signed on 05/08/2024 02:47 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:OUSD - ARROYO VIEJO CDCFACILITY NUMBER:
013422004
ADMINISTRATOR/
DIRECTOR:		JOY FORTE`FACILITY TYPE:
850
ADDRESS:1895 - 78TH AVETELEPHONE:
(510) 636-1254
CITY:OAKLANDSTATE: CAZIP CODE:
94621
CAPACITY: 72TOTAL ENROLLED CHILDREN: 46CENSUS: 32DATE:
05/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Caroline JonesTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 05/08/2024 at 11:45 AM Licensing Program Analyst (LPA), A. Curry conduct an unannounced visit to follow up on a self-reported unusual incident where a substitute teacher handled a child inappropriately. LPA met with Site Principal, Caroline Jones, to explain the purpose of today's visit. During the visit the LPA conducted interviews with staff. The interviews revealed that the teacher spoke to a child inappropriately by saying, "If you kick me, I am going to kick you back". (See 809D for deficiency that was cited today)


Exit interview conducted, appeal rights were given, and report was reviewed with the Site Principal, Caroline Jones.
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 02:47 PM - It Cannot Be Edited


Created By: Ashley Curry On 05/08/2024 at 12:31 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 - ARROYO VIEJO CDC
FACILITY NUMBER: 013422004

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2024
Section Cited
CCR
101223(a)(1)

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101223 Personal Rights(a)The licensee shall ensure that each child is accorded the following personal rights:(1)To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement was not met as evidence by:
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By 05/31/2024 the facility will conduct an all staff training on Personal Rights. Site Principal will email LPA attendance sheet for staff who attended the training.

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Based on interviews the facility did not comply with the section cited by not ensuring all children's personal rights are not violated by staff.
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Please see website below for a video on Children's Personal Rights in Child Care.

https://ccld.childcarevideos.org/child-care-center-operators/childrens-personal-rights-in-child-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: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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