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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700761
Report Date: 02/27/2024
Date Signed: 02/27/2024 04:22:31 PM

Document Has Been Signed on 02/27/2024 04:22 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:WONDER YEARS-NORTH MOUNTAIN VIEW, THEFACILITY NUMBER:
435700761
ADMINISTRATOR:LOVRIN, LORENAFACILITY TYPE:
850
ADDRESS:462 STIERLIN ROADTELEPHONE:
(650) 386-9666
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY: 133TOTAL ENROLLED CHILDREN: 133CENSUS: 98DATE:
02/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Lorena LovrinTIME COMPLETED:
04:40 PM
NARRATIVE
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On 02/27/2024, Licensing Program Analyst (LPA) Melanie Otsuji conducted an unannounced Case Management Visit - Incident inspection. LPA met with Director, Lorena Lovrin, and explained the nature of the visit. Also present during this visit were 18 additional staff members and 98 preschool aged children. A health and safety inspection was conducted.

On 1/22/2024 and 2/21/2024, the Director reported an Unusual Incident to the Regional Office (RO). The summary of the unusual incidents are as follows: On 1/21/2024 - C1 was utilizing the restroom and being supervised by S1. S1 asked S2 to stay and supervise C1 with S2's group while they used the restroom. S2 left the bathroom with her group leaving C1 on the potty unsupervised. Approximately 10 minutes had passed before C1 was removed from the bathroom. On 2/21/2024 - C2's class was outside on the play yard with S3 and S4. C2 was able to enter a classroom via open door where C2 sat down at a table without supervision. S5 noticed C2 and reported this incident to the director.

Based on the information received, a TYPE A deficiency is being cited on today's date, 2/27/2024 (see attached LIC809D).

LPA Otsuji informed facility representative, Lorena Lovrin, that this report dated 2/27/2024 document(s) one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Otsuji informed the facility representative to provide a copy of this licensing report dated 2/27/2024 that documents any Type A citation 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.

An exit interview was conducted where the citation and plan of correction were discussed. Appeal rights were given and explained to the Director, Lorena Lovrin

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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 02/27/2024 04:22 PM - It Cannot Be Edited


Created By: Melanie Otsuji On 02/27/2024 at 04:04 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: WONDER YEARS-NORTH MOUNTAIN VIEW, THE
FACILITY NUMBER: 435700761

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Director is to conduct a staff meeting with all staff. Agenda items covered during staff meeting to be provided to LPA along with signatures of all staff in attendance to be submitted to LPA via email no later than 2/28/2024.
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This requirement is not being met as evidence by: 2 children on two separate occasions were without visual supervision for a short duration of time. This poses an immediate risk to the health, safety, or personal rights to persons 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:Wynn Norona
LICENSING EVALUATOR NAME:Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024


LIC809 (FAS) - (06/04)
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