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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213461
Report Date: 05/29/2019
Date Signed: 05/29/2019 03:29:35 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:LIGHTHOUSE KIDDIE KINGDOMFACILITY NUMBER:
010213461
ADMINISTRATOR:RUSHING, EUGENEFACILITY TYPE:
850
ADDRESS:16053 ASHLAND AVENUETELEPHONE:
(510) 278-9386
CITY:SAN LORENZOSTATE: CAZIP CODE:
94580
CAPACITY:19CENSUS: 20DATE:
05/29/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Francine CurryTIME COMPLETED:
03:45 PM
NARRATIVE
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LPA Dayna Collier met with Center Director Francine Curry for a case management inspection. Present for the inspection were 4 staff members and 20 children. Per Director, she allowed a child to attend the facility today on a trial basis.

In addition, LPA was informed that an unusual incident had occurred which was not reported to Licensing as required.

The attached type A and type B deficiencies are cited today and must be corrected by the due dates.
Upon receipt, licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted and the report was discussed. Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.

A site visit notice was posted by Director.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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 3
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: LIGHTHOUSE KIDDIE KINGDOM
FACILITY NUMBER: 010213461
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2019
Section Cited
CCR
101212(d)
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101212 Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.

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POC: By 6/5/19, a written Unusual incident report will be prepared and sent to Licensing detailing the incident.
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This requirement was not met as evidenced by interviews conducted. This poses a potential risk to the health and safety of children in care.
WHEN AN ALLEGATION OF PERSONAL RIGHTS VIOLATION WAS RECEIVED, STAFF FAILED TO REPORT THE UNUSUAL INCIDENT TO LICENSING.
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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: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: LIGHTHOUSE KIDDIE KINGDOM
FACILITY NUMBER: 010213461
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/03/2019
Section Cited
CCR
101179(a)
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101179 Capacity Determination
(a) A license shall be issued for a specific capacity, which shall be the maximum number of children that can be cared for at any given time. The Department may issue a license for fewer children than requested.
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POC: By 6/3/19, the director stated that the capacity will be reduced by one child.
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This requirement is not met as evidenced by the census today. This poses an immediate risk to the health and safety of children in care.
TODAY, AT 1:10 P.M., LPA OBSERVED 20 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: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3