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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070206070
Report Date: 09/23/2024
Date Signed: 11/18/2024 02:57:57 PM

Document Has Been Signed on 11/18/2024 02:57 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:KING'S VALLEY PRESCHOOLFACILITY NUMBER:
070206070
ADMINISTRATOR/
DIRECTOR:		KETNER, MICHELEFACILITY TYPE:
850
ADDRESS:4255 CLAYTON ROADTELEPHONE:
(925) 687-2020
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY: 120TOTAL ENROLLED CHILDREN: 85CENSUS: 41DATE:
09/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:L. SartoriusTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 9/23/24 at 3:00 PM Licensing Program Analysts (LPAs) Joe Mary Vargas and Cherie Acosta conducted an unannounced case management visit and met with the director L. Sartorius.

During the a complaint investigation, director provided a copy of unusual incident report for an incident that occurred 9/17/24. C1 was briefly left in the classroom unsupervised. A parent found the child in the classroom and brought C1 out of the classroom to the play yard.

See LIC 809-D for deficiency cited today. Notice of site visit was provided and must be posted for 30 days.
Exit interview and report reviewed with L. Sartorius.
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Joe Mary Vargas
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
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 11/18/2024 02:57 PM - It Cannot Be Edited


Created By: Joe Mary Vargas On 09/23/2024 at 03:13 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: KING'S VALLEY PRESCHOOL
FACILITY NUMBER: 070206070

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Director should develop a written plan of action to ensure children are not left without supervison at anytime. Director shall submit a copy of this plan to CCL by 10/4/24.
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This requirement was not met as evidenced by: C1 was left in the classroom unsupervised on 9/17/24 which poses a potential risk to the health and saftey of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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:Joe Mary Vargas
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2024


LIC809 (FAS) - (06/04)
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