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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423130
Report Date: 07/15/2024
Date Signed: 07/15/2024 02:34:32 PM

Document Has Been Signed on 07/15/2024 02:34 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:ARBOR PRESCHOOL COLLEGEFACILITY NUMBER:
013423130
ADMINISTRATOR/
DIRECTOR:		JOHNSTON, KELLYFACILITY TYPE:
850
ADDRESS:5830 COLLEGE AVENUETELEPHONE:
(360) 461-6466
CITY:OAKLANDSTATE: CAZIP CODE:
94618
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 27DATE:
07/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Casey MooreheadTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On 07/15/2024 at 12:00 PM Licensing Program Analyst (LPA), A. Curry conducted an unannounced case management inspection. LPA met with the Director, Casey Moorehead, to explain the purpose of today's visit. LPA previously toured the facility and conducted interviews for a complaint that was received on 06/26/2024. Interviews revealed that the facility had a lice infestation, which lead to a temporary closure at the facility for deep cleaning. The Department was not notified of the lice infestation or the temporary closure (See 809D).

The director was advised that all epidemic outbreaks and closure of facility should be reported to the Department within the next working day of the incident occurring and the facility shall submit the LIC 624 Unusual Incident/Injury Report form to the Oakland office within 7 days of the incident occurring.

Exit interview conducted, appeal rights were given, and report was reviewed with the Director, Casey Moorehead.
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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 07/15/2024 02:34 PM - It Cannot Be Edited


Created By: Ashley Curry On 07/15/2024 at 12:12 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: ARBOR PRESCHOOL COLLEGE
FACILITY NUMBER: 013423130

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/29/2024
Section Cited
CCR
101212(d)(1)(E)

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101212(d)Upon the occurrence..of any of the events specified.. below, a report shall be made..by telephone or fax within the Department's next working day..a written report..shall be submitted to the Department within seven days..(1)Events reported..: (E)Epidemic outbreaks.
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By 07/29/2024 the facility will review the entire reporting requirements regulations section 101212. The facility will email LPA confirming the regulations were read and understood.
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This requirement is not met as evidence by:
Based on interviews and record review the facility did not comply with the section cited above by not notifying Licensing of the lice infestation, which poses as a potential risk to health, safety, and personal rights 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:Monica Mathur
LICENSING EVALUATOR NAME:Ashley Curry
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
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