<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212559
Report Date: 12/12/2019
Date Signed: 12/13/2019 11:17:37 AM

COMPREHENSIVE INSPECTION
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:LAKESHORE CHILDREN'S CENTERFACILITY NUMBER:
010212559
ADMINISTRATOR:THOMPSON, RAE RITA FFACILITY TYPE:
840
ADDRESS:3518-3546 LAKESHORE AVENUETELEPHONE:
(510) 893-4048
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY:65CENSUS: 43DATE:
12/12/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rita Rae ThompsonTIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Susan Neeson met with Rae Rita Thompson, Director for an unannounced annual/random inspection. Visit began at 11:30 AM. Present is the Director and 6 staff. Also present are 43 preschool age children. There are three buildings in which there are several rooms which are used at various times.

There is a working phone. The last fire/emergency drill was October 2019. There are adequate toys and equipment. There is adequate heating, ventilation, and lighting.

Inside, there iare storage areas for each child with cubbies. Director stated that there were no bodies of water or firearms on the premises. Director has emergency earthquake supplies.

Licensee is reminded that ALL assistants, volunteers or adults that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov and for day care updates visit www.myccl.ca.gov


Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. 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. Facility has children with asthma and needing an epipen. Plan of operation is needed for file.
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
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 4
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: LAKESHORE CHILDREN'S CENTER
FACILITY NUMBER: 010212559
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2019
Section Cited

1
2
3
4
5
6
7
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met in that there were two storage sheds on the yard that were not locked.
Type B
12/12/2019
Section Cited

1
2
3
4
5
6
7
Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement was not met in that there doors to industrial kitchen and janitor room unlocked in upper hall while children were playing there.
Type B
12/19/2019
Section Cited

1
2
3
4
5
6
7
Napping equipment (a) Cots used for napping shall be maintained in a safe condition.(c) Each cot or mat shall be equipped with a sheet to cover the cot or mat and, depending on the weather, a sheet and/or blanket to cover the child. This was not met in that 15 mats lacked sheets.

Type B
01/13/2020
Section Cited

1
2
3
4
5
6
7
Teacher Qualifications and Duties (a) In addition to Section 101216, the following shall apply: (b) Prior to employment, a teacher shall meet the requirements of (b)(1) or (b)(2). This was not met in that some staff lacked proof of units, Dr. & TB, immunizations and AB 1207 cert.

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: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: LAKESHORE CHILDREN'S CENTER
FACILITY NUMBER: 010212559
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/13/2019
Section Cited

1
2
3
4
5
6
7
Criminal Record Clearance ( e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or
8
9
10
11
12
13
14
(2) Request a transfer of a criminal record clearance as specified in Section 101170(f). This was not met in that one staff present today lacked fingerprint clearances.
8
9
10
11
12
13
14
Type A
12/19/2019
Section Cited

1
2
3
4
5
6
7
Limitations on Capacity and Ambulatory Status (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This was not met in that a child under age 2 (C1) has been attending the facility since September.
Type A
01/13/2020
Section Cited

1
2
3
4
5
6
7
Child Care Center Directors Qualifications and Duties (m) A child care director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866.This was not met. No staff present has the full 16-hour Health and Safety course. No staff has CPR and First Aid certificates.
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: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: LAKESHORE CHILDREN'S CENTER
FACILITY NUMBER: 010212559
VISIT DATE: 12/12/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The following documents were issued and discussed: Capacity sheet for large license, blue immunization forms, Flu prevention information, Quarterly update from Department, AB 1207 information, Safe Sleep for infants, Fire/earthquake drill information, Safe and healthy diapering, Parents Rights andLicensee rights. LIC 311 A, Food Service regulation, Personnel requirements and Director qualifications regulation were issued.

Copy of roster was requested. Copy of LIC 500 is requested.

Deficiencies are cited on 809 D.

Appeal Rights were discussed.

POC form was issued.
SUPERVISOR'S NAME: Antranette RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Susan NeesonTELEPHONE: (510)622-2630
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4