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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407453
Report Date: 12/13/2022
Date Signed: 12/13/2022 01:39:51 PM

Document Has Been Signed on 12/13/2022 01:39 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:GRACIE'S PLACE PRESCHOOLFACILITY NUMBER:
073407453
ADMINISTRATOR:PLATTS, DENISEFACILITY TYPE:
850
ADDRESS:17011 BOLLINGER CANYON ROADTELEPHONE:
(925) 302-9092
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY: 13TOTAL ENROLLED CHILDREN: 10CENSUS: 8DATE:
12/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Denise PlattsTIME COMPLETED:
01:35 PM
NARRATIVE
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On 12/13/2022 at 9:55am Licensing Program Analyst (LPA) Morgan Pringle met with Director Denise Platts, for an Unannounced Case Management Visit. LPA received an email from Director on 12/5/2022 informing LPA that there was construction being done in the facilities current building at 17011 Bollinger Canyon Rd., San Ramon, CA 94582 and the childcare center has been moved to the Rancho San Ramon Community Park Center at 1998 Rancho Park Loop, San Ramon, CA 94582. Director stated to LPA in the email that both buildings are San Ramon Community Centers and the city plans to have the childcare center return to its original location by 1/2023.

LPA Pringle conducted the inspection at the facility’s current location at the Rancho San Ramon Community Park Center. The facility operates in the Russel Room 104 and the children use the Bella Vista Room’s 123(A) and (B) for play. During the inspection there were eight (8) preschool children and the Director. Facility currently does not have any other staff members or volunteers. The facility operates from 9:00am – 1:00pm, Monday – Friday.

Director stated that all the furniture and materials from the original location was brought to the new location. The facility has ample age appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, cleaning products, and hazardous materials were observed to be in inaccessible areas. All children have access to clean drinking water in and outside of the classrooms. Room 104 is one large room with one (1) sink and two storage areas. Room 123 is a large open space with three (3) locked storage rooms. During LPA’s visit there were tables and chairs arranged in the shape of a square in a part of the room. There are carbon monoxide detectors, smoke detectors, and fully charged fire extinguishers on site.



Continued on LIC809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: GRACIE'S PLACE PRESCHOOL
FACILITY NUMBER: 073407453
VISIT DATE: 12/13/2022
NARRATIVE
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The facility is operating within their licensed capacity and is in ratio. All required postings are made visible by the entrance of room 104. The fire/disaster drill log is complete with the last drill logged 11/23/2022. A physical census of the children was taken and cross referenced with the sign-in and out log. Two (2) children were not properly signed in by their authorized representative. LPA obtained the facilities files, children’s files and staff files. All files were complete.

During LPA’s visit Director stated that the children currently use the women’s adult bathroom across the hall from the Bella Vista Room. The bathroom has 8 adult stalls and 3 sinks. Director states that all the children go into the bathroom together for proper supervision. Director also stated that the school moved to the new location back in September and will be going on winter break from 12/23/2022 to 1/6/2023. LPA Pringle informed Director that a license issued to a center is attached to the physical facility and not necessarily to the person in charge of the facility. LPA Pringle informed Director that moving locations without informing the department, not filling out an application and not following the proper protocols is operating without a license. Due to this a Type A citation will be cited during LPA’s visit.

Type A Deficiency Cited
· Failure to submit new application and inform Department of location change

Type B Deficiency Cited
· Two (2) children not properly signed in

Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). LPA Pringle informed Director that Unusual Incidents include any construction, structural changes, location changes and/or damages to the facility. Incidents must be reported within 24 hours by phone, fax, or email.

Continued on LIC809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
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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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: GRACIE'S PLACE PRESCHOOL
FACILITY NUMBER: 073407453
VISIT DATE: 12/13/2022
NARRATIVE
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LPA Pringle informed licensee Denise Platts that this report dated 12/13/2022 document(s) one (1) Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Pringle informed the licensee to provide a copy of this licensing report dated 12/13/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director Denise Platts.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/13/2022 01:39 PM - It Cannot Be Edited


Created By: Morgan Pringle On 12/13/2022 at 12:20 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: GRACIE'S PLACE PRESCHOOL
FACILITY NUMBER: 073407453

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/23/2022
Section Cited
CCR
101185(b)

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101185(b) When a licensee proposes a ...change in location, the licensee may, in lieu of filing an entirely new LIC 281A (12/96) and supporting documents as specified in Section 101169, transfer documents from an existing application to a new application...
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Director will submit an Application for a change of location from the old facility to the new temporary location. Director will submit a new application and any other updated forms needed.
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This requirement was not met as evidenced by: Director relocated to a new location without submitting an application or properly notifying the department which poses an immediate risk to the health and safety of the children in care.
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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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022


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Document Has Been Signed on 12/13/2022 01:39 PM - It Cannot Be Edited


Created By: Morgan Pringle On 12/13/2022 at 12:25 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: GRACIE'S PLACE PRESCHOOL
FACILITY NUMBER: 073407453

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited
CCR
101229.1(a)(1)

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101229.1(a)(1) The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement was not met as evidenced by: Director did not ensure all children were properly signed into the facility which poses a potential risk to the health and safety to the chidren in care.
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Director will send LPA the corrected sign in/out log for the two children. Director will remind parents to complete the sign in/out log everyday.

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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:Jason Jang
LICENSING EVALUATOR NAME:Morgan Pringle
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022


LIC809 (FAS) - (06/04)
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