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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400296
Report Date: 04/14/2022
Date Signed: 04/14/2022 11:17:50 AM

Document Has Been Signed on 04/14/2022 11:17 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:CHILDREN'S PRE-SCHOOL CENTER, THEFACILITY NUMBER:
434400296
ADMINISTRATOR:KAY ERIKSONFACILITY TYPE:
850
ADDRESS:4000 MIDDLEFIELD ROAD T-1TELEPHONE:
(650) 493-5770
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 112TOTAL ENROLLED CHILDREN: 87CENSUS: 72DATE:
04/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Adora GarrickTIME COMPLETED:
11:31 AM
NARRATIVE
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On 4/14/2022, Licensing Program Analyst (LPA) Jonathan Williams arrived to the facility unannounced for the purposes of conducting a Case Management visit in response to an unusual incident reported by facility Director. LPA was met by Director, Adora Garrick, 17 fingerprint cleared and associated staff members, and 72 preschool aged children in care.

On 4/12/2022, facility Director reported an unusual incident to the Department. In the report, Director stated that on 4/11/2022 at approximately 4:45pm, a parent of a child in care observed a child unrelated to her (C1) unaccompanied by a teacher inside a hallway. Per Director, the parent stated that C1 had entered into the hallway from the outdoor play area near the classroom where the parent was attending to her own child. Director stated that the parent immediately brought C1 back to the child's teacher upon observing C1 in the hallway unaccompanied. Director stated that the child was left unsupervised by a teacher for a period of seconds before being noticed by the parent and being brought back to his teacher.

Director is advised that CCR 101229(a)(1) states the following:

"No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation."

Type A deficiency is cited pursuant to CCR 101229(a)(1). Director was advised LIC9224 must be delivered to and signed by all current parents of children and parents of all children subsequently enrolled for a period of 12 months from today's date.

Exit interview conducted. Appeal rights provided.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2022
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 04/14/2022 11:17 AM - It Cannot Be Edited


Created By: Jonathan Williams On 04/14/2022 at 10:46 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: CHILDREN'S PRE-SCHOOL CENTER, THE
FACILITY NUMBER: 434400296

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/14/2022
Section Cited
CCR
101229(a)(1)

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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 terminated the teacher responsible for supervising C1. Director held a staff meeting on 4/13/2022 reviewing regulations regarding supervision of children.
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On 4/11/2022, a child was left unattended for a brief period before being noticed by a parent. This presents an immediate risk to the health and safety of children in care.
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Repeat violations will result in immediate civil penalty assessment.

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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:Wynn Norona
LICENSING EVALUATOR NAME:Jonathan Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022


LIC809 (FAS) - (06/04)
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