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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070207368
Report Date: 09/23/2022
Date Signed: 03/15/2023 09:24:26 AM

Document Has Been Signed on 03/15/2023 09:24 AM - 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:MORAGA VALLEY PRESBYTERIAN CHURCH NURTURYFACILITY NUMBER:
070207368
ADMINISTRATOR:KELLAHER, CONNIEFACILITY TYPE:
850
ADDRESS:10 MORAGA VALLEY LANETELEPHONE:
(925) 376-4800
CITY:MORAGASTATE: CAZIP CODE:
94556
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 63DATE:
09/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Carolyn NakaoTIME COMPLETED:
11:25 AM
NARRATIVE
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This an amended report based on the deficiency being overturned on appeal where the type A citation was reduced to a Type B and a civil penalty was waived.

On September 23, 2022 at 9:05am Licensing Program Analyst (LPA) Indira Loza arrived at the facility to conduct a case management visit as a direct result from a self reported Unusual Incident where a child was left alone on the playground while transition was taking place. Although the fingerprint cleared janitor witnessed the incident, the child was still left unsupervised by a qualified preschool staff.

Upon meeting with the Director, LPA was informed that the staff who left the child outside alone, already had a documented oral counseling letter, which is an informal disciplinary letter with the Director and received additional training. There was also a meeting scheduled to discuss how to prevent lack of supervision situations.


Exit interview conducted with Director Carolyn Nakao, and a copy of this report was provided. Appeal rights were provided.

A notice of site visit was provided and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2022
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 03/15/2023 09:56 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/10/2023 12:25 PM


Created By: Indira Loza On 09/23/2022 at 10:30 AM
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: MORAGA VALLEY PRESBYTERIAN CHURCH NURTURY
FACILITY NUMBER: 070207368

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/23/2022
Section Cited
CCR
101229(a)(1)

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(1) No child(ren) shall be left without the supervision of a teacher at any time.[..] Supervision shall include visual observation. This requirement was not met as evidenced by:
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Director shall conduct a meeting with staff about the importance of maintaning supervision of all children. All staff shall watch the "Supervising Children in Child Care Centers" video on the CCL website, and submit a statement of what was learned as well a sign in sheet from the
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A child was left outside by themselves on the playground, with a lack of supervision from a teacher. This poses a potential risk to the health and safety of the children in care.
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meeting. Director shall email the statements and sign in sheet to LPA by October 24, 2022.

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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:Mayla Mendoza
LICENSING EVALUATOR NAME:Indira Loza
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2022


LIC809 (FAS) - (06/04)
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