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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206128
Report Date: 06/09/2022
Date Signed: 06/09/2022 05:43:42 PM


Document Has Been Signed on 06/09/2022 05:43 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:OUSD - LAURELFACILITY NUMBER:
010206128
ADMINISTRATOR:TRAVERS, SHARONFACILITY TYPE:
850
ADDRESS:3825 CALIFORNIA STREETTELEPHONE:
(510) 531-6226
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:60CENSUS: 18DATE:
06/09/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:TRAVERS, SHARONTIME COMPLETED:
06:00 PM
NARRATIVE
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On 6/9/2022 at 9:15AM, Licensing Program Analyst (LPA) Catherine Fernandes and Licensing Program Manager (LPM) Loretta Dyson met with Director Sharon Travers. LPA and LPM observed 18 preschoolers in care with 9 staff.

While conducting an annual inspection for OUSD- Hintil Preschool (license number 010106131) located at 11850 Campus Drive in Oakland, LPA and LPM observed that OUSD Laurel Preschool has relocated and is operating at the site.
LPA and LPM spoke to Director Travers whom confirmed they relocated on 6/1/22 and has been providing care since 6/2/22. She stated the Laurel location is under construction and will not be ready for at least a year. The program is utilizing three classrooms and the outdoor space is being shared between the two programs. One of the three classrooms has been licensed under the Hintil preschool while the other two classroom have not been licensed or approved for child care.
In the past, the center had mentioned a possible transfer to Hintil and although Licensing has provided information to the necessary steps, Licensing never received any notification or application to request a change of location.

A Type A deficiency was cited during this visit. Licensee must provide a copy of this report to all parents of children currently enrolled, and the parents of newly enrolled children in the next 12 months. In addition, form LIC 9224 (Acknowledgment of Receipt of Licensing Reports) must be signed by each parent and placed in each child's file. A copy of the LIC 9224 was provided to the Director during the visit.

See 809D for deficiencies cited.
Exit interview conducted
Report and Appeal Rights provided.
Notice of site visit needs to be posted for 30 days.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


Document Has Been Signed on 06/09/2022 05:43 PM - It Cannot Be Edited

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, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: OUSD - LAUREL
FACILITY NUMBER: 010206128

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/10/2022
Section Cited

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Limitations on Capacity- A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement has not been met as evidenced by:
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Based on observations and conformation from the Director, the center relocated and started providing care to children at another location that has not been approved by Licensing, which poses an immediate risk to the health and safety of 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: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 06/09/2022 05:43 PM - It Cannot Be Edited

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, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: OUSD - LAUREL
FACILITY NUMBER: 010206128

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2022
Section Cited

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Alterations to Existing Buildings or New Facilities Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s).

This requirement is not met as evidenced by:
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Based on information obtained during an interview, the center did not comply with the section cited above because the center's building is under construction and Licensing was not notified. This poses a potential risk to the health and safety of 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: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3