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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423044
Report Date: 08/31/2023
Date Signed: 08/31/2023 01:43:57 PM

Document Has Been Signed on 08/31/2023 01:43 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:AU BEAU SEJOUR FRENCH PRESCHOOLFACILITY NUMBER:
013423044
ADMINISTRATOR:REFES, LILLIAFACILITY TYPE:
850
ADDRESS:860 30TH STREETTELEPHONE:
(510) 817-4532
CITY:OAKLANDSTATE: CAZIP CODE:
94608
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 37DATE:
08/31/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lillia RefesTIME COMPLETED:
02:00 PM
NARRATIVE
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On 8/31/23 Licensing Program Analysts (LPAs) Monica Mathur and Ashley Akinleye conducted an unannounced Case Management inspection at Au Beau Sejour French Preschool and met with Director, Lillia Refes.

During a complaint investigation on 8/31/23 it was determined that facility failed to notify Licensing Department about an unusual incident that occurred on 6/12/23 where a child C1 was left unsupervised in the class restroom for at least 10 minutes. Facility also failed to notify C1's parents about the incident. Director stated she was unaware it was a reportable incident.

Deficiency is cited on 809-D page. Exit interview was conducted, report reviewed with Director, Lillia Refes

A NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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 08/31/2023 01:43 PM - It Cannot Be Edited


Created By: Monica Mathur On 08/31/2023 at 12:59 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: AU BEAU SEJOUR FRENCH PRESCHOOL
FACILITY NUMBER: 013423044

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2023
Section Cited
CCR
101212(d)(1)(C)&(f)

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(d) Upon the occurrence, during the operation of the child care center of any of the events specified a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.(1) Events reported shall include the following:(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child (f) shall also be reported to the child's authorized representative
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By POC Due Date 9/8/23 Director agreed to submit a written statement of their understanding of the regulations for reporting requirements.
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Per investigation, facility failed to report unusual incident of child C1 left without visual supevision in class bathroom for atleast 10 minutes. This poses a potential risk to safety of children in 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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023


LIC809 (FAS) - (06/04)
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