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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212304
Report Date: 02/19/2020
Date Signed: 02/19/2020 05:04:15 PM

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:ST. LEO'S PRE-KINDERGARTENFACILITY NUMBER:
010212304
ADMINISTRATOR:MIAKA HILLFACILITY TYPE:
850
ADDRESS:4238 HOWE STREETTELEPHONE:
(510) 654-7828
CITY:OAKLANDSTATE: CAZIP CODE:
94611
CAPACITY:25CENSUS: 18DATE:
02/19/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Miaka Hill and Jeanette EichelbergerTIME COMPLETED:
05:15 PM
NARRATIVE
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On 02/19/20 at 01:00 PM Licensing Program Analysts (LPAs) Arminder Singh and Monica Mathur, conducted an unannounced Required inspection of ST. Leo's Pre-Kindergarten. LPAs met with Director, Miaka Hill and Office Manager, Jeanette Eichelberger and explained the purpose of today's inspection. Facility's operating days and hours are Monday thru Friday, 7:00 AM-6:00 PM. Facility is located in the premises St Leo The Great Catholic School in the Pre-Kindergarten Classroom located near the science room of the school.

At 01:30 PM the physical plant was inspected. LPA toured the premises.
Indoor space: The classroom, restroom were inspected. Present today were 18 children,
Director, and 2 teachers. At the time of arrival children were napping. Facility was observed to be in compliance with teacher to children ratio requirement during LPAs' inspection. Cleaning solutions and other items that are dangerous to the heath and safety of children were stored in places inaccessible to them. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Children bring their own lunch and snacks. Trash cans for solid waste had tight-fitting covers on and were in good repair. Director stated that facility does not possess nor store any weapons on the premises. LPA observed an operable Fire extinguisher, Smoke and Carbon Monoxide Detectors, fire pull stations, and sprinkler system. Fire Drills are conducted every month. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles.
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SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
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 7
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: ST. LEO'S PRE-KINDERGARTEN
FACILITY NUMBER: 010212304
VISIT DATE: 02/19/2020
NARRATIVE
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LPA reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person. LPA also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.


Deficiencies were cited today. Please see 809-D Page.


At 4:30 PM Exit Interview was conducted, where this report and deficiencies were reviewed and discussed with Director. Report was signed by the Director confirming receipt of documents.

Website for provider resources:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates
OR EMAIL TO:
childcareadvocatesprogram@dss.ca.gov


A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
LIC809 (FAS) - (06/04)
Page: 2 of 7
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: ST. LEO'S PRE-KINDERGARTEN
FACILITY NUMBER: 010212304
VISIT DATE: 02/19/2020
NARRATIVE
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Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe . The play equipment was maintained in good condition and free of hazards. Shade is provided by building overhang. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.

File Review: Children sign in and out procedures and logs were reviewed. 2 out of 18 children were not signed in today. 4 out of 16 were signed in by a teacher. Jeanette and Miaka stated that children are often dropped off at the parking lot with a teacher. Parents leave from there and the teacher takes the responsibility of signing in place of the authorized representative. This is a repeat violation under the same regulation within 12 months. Civil penalty of $250 is assessed.
A sampling of seven (7) Children's files (C1-C7), Director and 2 Staff files(S1-S2) was taken for review. All children had complete files except C6 who did not have any required licensing forms. Staff files did not contain any licensing forms and documents. Director has current certification in Pediatric CPR and First Aid present at the facility during inspection.

Director stated that facility does handle medications and currently have children in care who require Individual Medical Services. Isolation of sick child was discussed, and Director explained that a sick child is brought to an back corner area in the room to be isolated from other children. An adult restroom is used if necessary. Child is always under visual supervision while being cared for.
The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Beginning January 1, 2019 AB 2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

"Mandated Reporter" training for CA Child Care Providers per AB1207 that all staff are required to complete as of January 1, 2018. [Starting May 2019, both General Training followed by Child Care Providers Training is required to be taken]. The website for the online training is: http://www.mandatedreporterca.com/training/childcare.htm.

CONTINUED ON NEXT PAGE
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020
LIC809 (FAS) - (06/04)
Page: 3 of 7
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: ST. LEO'S PRE-KINDERGARTEN
FACILITY NUMBER: 010212304
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/26/2020
Section Cited

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101229.1(a)(1) Sign In and Sign Out: In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain, and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following [...]
This requirement was not met as evidenced by:
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Per LPA's review of sign in and sign out records, 2 out of 18 present today were not signed in. 4 out of 16 were signed in by a teacher. This has been occuring frequently on a daily basis. This poses a potential health risk to the health and safety of children in care.
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This is a repeat violation within 12 months. Civil penalty of $250 is assessed.
Type B
02/26/2020
Section Cited

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101217 Personnel Records
Per regulation all employees files must contain required licensing forms and documents. This requirement is not met as evidenced by:
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Per LPA's review of records S1 and S2 do not have any required licensing documents and forms including LIC 508, LIC 9108, LIC 9052, LIC 501, LIC 503. 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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2020
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: ST. LEO'S PRE-KINDERGARTEN
FACILITY NUMBER: 010212304
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/19/2020
Section Cited

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1596.7995 Employees or volunteers at day care center; immunization requirements; records; exemptions
Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.[..]This requirement was not met:
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Per LPA's review of staff files. S1 and S2 do not have any documentations on measles, influenza, and pertussis. This poses a potential risk to the health and safety of children in care.
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Type B
04/06/2020
Section Cited

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1596.8662 (b)(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided [...] This requirement was not met:
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Per LPA's reviews of file S1 and S2 do not have mandated reporter training. 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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2020
LIC809 (FAS) - (06/04)
Page: 5 of 7
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: ST. LEO'S PRE-KINDERGARTEN
FACILITY NUMBER: 010212304
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/26/2020
Section Cited

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101221(a) Child's Records
A separate, complete and current record for each child is maintained in the child care center.
This requirement was not met as evidenced by:
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Per LPA's review of files, C6 is missing licensing documents such as LIC700, LIC 627, LIC 613A, and LIC 995. This poses a potential risk to the health and safety of children in care.
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Type B
02/26/2020
Section Cited

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Each child day care facility shall maintain a current roster of children who are provided care in the facility [...]. This roster shall be available to the licensing agency upon request. This requirement is not met as evidenced by:
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Per LPAs review and inspection of files, Director failed to provide the Roster. 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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2020
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: ST. LEO'S PRE-KINDERGARTEN
FACILITY NUMBER: 010212304
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/26/2020
Section Cited

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101223(b)(2) Personal Rights
The center shall post a copy of the LIC 613A (9/96) in a prominent, publicly accessible area in the center.This requirement was not met as evidenced:
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Per LPA's observation this was not posted in the facility. This poses a potential risk to the health and safety of children in care,
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Type B
02/26/2020
Section Cited

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101174 (a) Disaster and Mass Casualty Plan
Each licensee shall have a disaster and mass casualty plan of action. The plan shall be in writing and shall be readily available. This requirement was not met as evidenced:
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Per LPA's observation Emergecy Disaster Plan (LIC 610) was not posted in the facilitiy. 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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Arminder SinghTELEPHONE: (510) 622-2634
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2020
LIC809 (FAS) - (06/04)
Page: 7 of 7