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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422059
Report Date: 05/18/2023
Date Signed: 05/18/2023 01:23:57 PM

Document Has Been Signed on 05/18/2023 01:23 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:PUSD - STEAM PRESCHOOLFACILITY NUMBER:
013422059
ADMINISTRATOR:BLANCA NEUMANNFACILITY TYPE:
850
ADDRESS:4667 BERNAL AVETELEPHONE:
(925) 462-4700
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 21DATE:
05/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Blanca NeumannTIME COMPLETED:
02:30 PM
NARRATIVE
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On May 18, 2023 at approximately 11:25 am, LPA Lorraine Dacanay Breaux arrived unannounced for a Case Management Inspection at PUSD STEAM Preschool for an Unusual Incident reported on April 17, 2023. LPA Dacanay Breaux meet with Director, Blanca Neumann and explained the purpose of the inspection. Present for today's inspection was twenty-one (21) pre-school children and five (5) staff.

The purpose of the visit was to follow up on an unusual incident filed on April 17, 2023. The incident occurred on April 17, 2023 at approximately 10:40am involving a child 4 years of age that was found alone in classroom 2 for approximately four (4) minutes. Director notified Community Care Licensing, family and submitted Unusual Incident report on April 17, 2023.

LPA Dacanay Breaux conducted interview with the director, the teacher that left a child in the classroom resigned from PUSD around May 4, 2023. LPA Dacanay Breaux inspected the premises, rooms and outdoor space, observed classrooms, reviewed and obtained relevant records and documents.

LPA inspected the premises, rooms and outdoor space, observed staff and children interactions, interviewed staff and children; reviewed and obtained relevant records and documents.

Deficiency was cited during today's inspection (see 809-D). This report was reviewed and discussed with Director Blanca Naumann, who signed it acknowledging receipt of documents. Facility will provide LIC9224 to every current family and any new families for next 12 months.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS. Appeal Rights provided and exit interview with Director, Blanca Naumann.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2023
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 05/18/2023 01:23 PM - It Cannot Be Edited


Created By: Lorraine Dacanay-Breaux On 05/18/2023 at 12:26 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: PUSD - STEAM PRESCHOOL
FACILITY NUMBER: 013422059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/01/2023
Section Cited
CCR
101229(a)(1)

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Title 22, Division 12, Chapter 1, Section 101229(a)(1) No child(ren) shall be left without the supervision of a teacher at any time. Supervision shall include visual supervision.

This regulation is not met as evidenced by:
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Per Director the staff recevied discpline action and staff resigned May, 2023. ALL STAFF during April and May staff meetings reviewed active supervision procedures and protocols for supervising children in care. Each staff member will sign and date the provided Active Supervision statement.
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The facility did not ensure proper supervision resulting in a child being left alone in a classroom for approximately four (4) minutes, which poses a potential health, safety, or personal rights risk to children in care.
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DIrector will have each staff members sign this written statement as an acknowledgement. Plan of action on how the school will ensure supervision at all times.
Statement will be emailed to LPA
Lorraine.Dacanay-Breaux@dss.ca.gov by June 1, 2023.

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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:Chandra Charles
LICENSING EVALUATOR NAME:Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2023


LIC809 (FAS) - (06/04)
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