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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407440
Report Date: 08/21/2024
Date Signed: 08/21/2024 04:29:50 PM

Document Has Been Signed on 08/21/2024 04:29 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:FOREST HILLS PRESCHOOL AND CHILD CARE CENTERFACILITY NUMBER:
073407440
ADMINISTRATOR/
DIRECTOR:		WATAWALA, MARLAFACILITY TYPE:
850
ADDRESS:127 MIDHILL RDTELEPHONE:
(925) 228-0611
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY: 72TOTAL ENROLLED CHILDREN: 64CENSUS: 47DATE:
08/21/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Marla Watawala and Terese BagleyTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta and Joe Mary Vargas conducted an unannounced case management visit. LPAs met with Program Director Marla Watawala and Site Director Terese Bagley.

During the visit it was discovered that S1 did not have criminal record clearance. Director was informed that S1 must have a criminal record clearance and must be associated to the facility prior to returning to the facility after the close of business today,

See 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 Terese Bagley
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2024
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 08/21/2024 04:29 PM - It Cannot Be Edited


Created By: Cherie Acosta On 08/21/2024 at 03:06 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: FOREST HILLS PRESCHOOL AND CHILD CARE CENTER
FACILITY NUMBER: 073407440

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2024
Section Cited
CCR
101170(e)(1)

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Criminal Record Clearance.All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
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Director shall submit a letter to CCL by 8/22/24 ensuring that S1 will not be in the presence of children until she has criminal record clearance and is associated to the facility. Director shall also review the regulation and
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Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidence by: S1 did not have criminal record clearance which is a potential risk to the health and safety of children in care.
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submit a letter to CCL by 8/22/24 ensuring that she understands the regulation and shall remain in compliance.

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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2024


LIC809 (FAS) - (06/04)
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