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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700598
Report Date: 02/08/2024
Date Signed: 02/08/2024 03:54:13 PM

Document Has Been Signed on 02/08/2024 03:54 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:PLAY PALS SPACE, LLCFACILITY NUMBER:
015700598
ADMINISTRATOR:TORRES, JENNELLEFACILITY TYPE:
850
ADDRESS:14207 E. 14TH STREETTELEPHONE:
(510) 612-5862
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 7DATE:
02/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Jacqueline Dia De LeonTIME COMPLETED:
04:20 PM
NARRATIVE
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On February 8, 2024, Licensing Program Analyst (LPA)Lorraine Dacanay Breaux arrived at the Facility unannounced for a complaint investigation against the license. LPA met with director, Jacqueline Dia DeLeon. Also present during the inspection was three (3) staff and seven (7) preschool children in care. LPA found a deficiency unrelated to the complaint resulting in this case management report.

Upon arrived LPA Dacanay Breaux observed the room temperature was at 57 degrees, LPA informed the facility representative that it was too cold and the heater needed to be turned on, per Title 22 regulations room temperature should be at least 68 degrees. The facility representative stated the heater was broken and showed the LPA one portable heater located on the left side of the room where the children would nap. Facility representative stated that the heater for the site is broken and has not been working for a few months. At 1:35PM the temperature at the site was 61 degrees, LPA noted that the children had on coats to sleep and blankets.

LPA did a consultation with the director and provided copies of the following Title 22 Regulations: 101239
Due to the classroom temperature not being maintained at a comfortable level of at least 68 degrees, a Type B Violation is being cited today. Please see the attached deficiency page LIC 809-D.

LPA requested for the staff file and after reviewing LPA discovered the staff files are to be found incomplete. Four (4) Staff files were reviewed (including the director) did not have the following: Mandated Reporter Training, transcripts, Child abuse, Employee Rights and immunization records. Facility missing LIC 500 and LIC 9040. LPA provided copies to director .

LPA did a consultation with the director and provided copies of the following Title 22 Regulations: 101215.1 (Child Care Center Director Qualifications and Duties) and 101217 (Personnel Records)
Due to the school not having the personnel records available, LPA unable to verify qualifications a Type B Violation is being cited today. Please see the attached deficiency page LIC 809-D.

A notice of site visit was given and must remain posted for 30 days. Appeals rights were given and reviewed.
Exit interview was conducted and report was reviewed with the Director, Jacqueline Dia De Leon.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
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 02/08/2024 03:54 PM - It Cannot Be Edited


Created By: Lorraine Dacanay-Breaux On 02/08/2024 at 12:57 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: PLAY PALS SPACE, LLC
FACILITY NUMBER: 015700598

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/12/2024
Section Cited
CCR
101239(a)(1)(A)

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101239(a)(1)(A)
Fixtures, Furniture, Equipment and Supplies. The licensee shall maintain the temperature in rooms that children occupy between a minium of 68 degrees F(20 degrees C) and a maximum of 85 degrees F (30 degrees C) In areas of extreme heat, the maximum shall be 20 degrees F (11.1 degrees C) less than the outside temperature.
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The center will acquire additional portable heaters units purchases and will place a unit in each classroom, to ensure the temperature is comfortable. The facility representative will send proof to LPA by or email. Licensee will also send pictures of the heaters by POC due date.
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Based on observation and interviews with facility representative the building heater is not working and has not in a few months, one classroom has a portable heater (nap room) for the children. This poses a potential health, safety and personal rights risk to persons in care.
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Type B
03/01/2024
Section Cited
CCR101217(a)

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101217 Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee.
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Director will obtain all required documents for all current staff, including substitute staff/volunteers, and have them maintained at the facility at all times. LPA Breaux will return to review records and verify that the POC has been met.
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Based on record review the facility files were found incomplete. This poses a potential health, safety and personal rights risk to persons in care.
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Director will create a plan and submit to LPA on how she will ensure that personnel files will be maintained going forward. Director will email the plan to LPA:
Lorraine.Dacanay-Breaux@dss.ca.gov
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: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024


LIC809 (FAS) - (06/04)
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