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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070207368
Report Date: 11/06/2025
Date Signed: 11/06/2025 10:47:47 AM

Document Has Been Signed on 11/06/2025 10:47 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MORAGA VALLEY PRESBYTERIAN CHURCH NURTURYFACILITY NUMBER:
070207368
ADMINISTRATOR/
DIRECTOR:		CAROLYN NAKAOFACILITY TYPE:
850
ADDRESS:10 MORAGA VALLEY LANETELEPHONE:
(925) 376-4800
CITY:MORAGASTATE: CAZIP CODE:
94556
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 86DATE:
11/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Carolyn NakaoTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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On November 6, 2026, Licensing Program Analyst (LPA) Lorraine Dacanay Breaux met with Director Carolyn Nakao for an Unannounced Case Management - Incident Visit. Present during the visit were seventeen (17) staff (includes administrative staff) and eighty-six (86) children in care. LPA toured the facility and conducted an interview with the facility Director. The facility operates Monday - Friday from 7:00 AM – 6:00 PM.

The purpose of today's visit is to follow up to an unusual incident report (LIC 624) submitted by the director on 10/10/2025. The facility did self report. The incident was in regards to C1 being left unattended in the bathroom. Per director the S2 was unaware that C1 entered into the bathroom.

Based on the Unusual Incident report received at the time this incident occurred and staff interview conducted by the LPA, the facility is being issued a Type B citation for lack of supervision. (See LIC809 - D)



The Director was proactive in aiming to preventive future situations by providing of additional training to staff which was completed on 10/13/2025. According to the Director, the training included a debriefing and retraining session that involved viewing the CCLD video titled "Supervision". Staff member S2 also received individual training. Director also added a child's safety gate at the bathroom as a preventive measure.

Notice of site visit was given and must remain posted for 30 days. Report read and appeal rights given to Center Director, Carolyn Nakao.

End of Report

NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Lorraine Dacanay-Breaux
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 11/06/2025 10:47 AM - It Cannot Be Edited


Created By: Lorraine Dacanay-Breaux On 11/06/2025 at 10:10 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
, 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: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2025
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation. This requirement is not met as evidenced by:
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Director provided LPA proof of training to staff regarding supervision to children in care. Staff watched the CCLD Video "supervision".
Proof was received during LPA visit on 11/6/25.
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Based on interview and documentation/record review, the facility did not comply with the section cited above in that a child was left unsupervised, which poses an potential health, safety or personal rights risk to children in care.

Child was left unsupervised in the bathroom for about 3 minutes. This poses an immediate risk to the health and safety of children in care.

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POC was cleared during today's visit.

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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.
Chandra Charles
NAME OF LICENSING PROGRAM MANAGER:
Lorraine Dacanay-Breaux
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2025


LIC809 (FAS) - (06/04)
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