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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423067
Report Date: 02/15/2023
Date Signed: 02/15/2023 03:01:58 PM

Document Has Been Signed on 02/15/2023 03:01 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:OAK CENTER CULTURAL CENTER, INC.FACILITY NUMBER:
013423067
ADMINISTRATOR:JORDAN, MARYFACILITY TYPE:
850
ADDRESS:1324 ADELINE STREETTELEPHONE:
(510) 891-0035
CITY:OAKLANDSTATE: CAZIP CODE:
94607
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 17DATE:
02/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:DELTRINA JOHNSONTIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst Tasha Alexander met with Center Director Deltrina Johnson to discuss a self reported unusual incident involving a teacher and day care child.

Today staff interviews were conducted as well as a tour of the facility. During today's interviews it was revealed that in an attempt to keep children from climbing on a bookshelf, a teacher "swat" a child on the forehead when she swung her hand backward. The child did not appear to be hurt and did not cry. There were no bruises. The teacher denies intentionally hitting the child, but meant to move the child back. Parents were notified of the incident. The child is still in care.

Please see attached 809-d for citation

An exit interview was conducted.

A notice of site visit was posted.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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 02/15/2023 03:01 PM - It Cannot Be Edited


Created By: Tasha Hackett-Alexander On 02/15/2023 at 02:37 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: OAK CENTER CULTURAL CENTER, INC.
FACILITY NUMBER: 013423067

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2023
Section Cited
CCR
101223

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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 including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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Licensee will conduct an all staff training on child personal rights. Licensee will submit to community care licensing a staff sign in sheet of all in attendance and a summary of the training and changes that will be made to prevent future incidents by 3/1/23. Lpa discussed TSP program and supervision with center director. Should she want to enroll, contact lpa for referral
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This requirement was not met as evidence by: interviews and self reported unusual incident; in an attempt to keep several children from climbing a bookshelf, a teacher "swat" a child on the forehead when she swung her hand backward.
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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:Loretta Dyson
LICENSING EVALUATOR NAME:Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023


LIC809 (FAS) - (06/04)
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