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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010216194
Report Date: 10/26/2022
Date Signed: 10/26/2022 02:50:06 PM


Document Has Been Signed on 10/26/2022 02:50 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:DAVIS STREET CHILD CARE AT GARFIELD SCHOOLFACILITY NUMBER:
010216194
ADMINISTRATOR:PATTEN, MARYFACILITY TYPE:
840
ADDRESS:13050 AURORA DRIVETELEPHONE:
(510) 567-0322
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:40CENSUS: 0DATE:
10/26/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Lacy McHenry & Deborah MiddletonTIME COMPLETED:
02:49 PM
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On Wednesday 10/26/2022 at approximately 2:00PM, Licensing Program Analyst (LPA) Sabina Dodoo, Licensing Program Manager(LPM) Chandra Charles, and Regional Manager(RM) Anika Evans, conducted an Announced in Office Informal Meeting with Teacher Lacy McHenry and Chief Human Resources Officer Deborah Middleton. The purpose of this meeting was to discuss with Teacher Lacy McHenry her Caregiver Provider Background Clearance status. The meeting also discussed how the Davis Street facilities can remain in compliance with the California Title 22 Regulations.

At the beginning of the meeting Teacher Lacy McHenry was asked by LPM Charles to provide proof of identification documents and proof of her social security number. A copy of these documents were obtained. Chief Human Resources Officer Deborah Middleton and Teacher Lacy McHenry were also provided with a copy of court documents of a case that was filed against Lacy McHenry on April 15th, 2009. At the time Ms. Lacy McHenry was employed at Supporting Future Growth -Site III, Facility Number: 013419409, in the position of Site Supervisor.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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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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: DAVIS STREET CHILD CARE AT GARFIELD SCHOOL
FACILITY NUMBER: 010216194
VISIT DATE: 10/26/2022
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The case was pertaining to the following allegations:

1. Lack of supervision due to a child eloping thru the gates of the school.

2. Children being placed in a room with the door closed

3. Teacher Aides left to supervise children without a fully qualified teacher present.

LPM Charles and RM Anika Evans discussed the history of the court case with Teacher Lacy McHenry in which she acknowledged the events in this case occurred. LPM Charles and RM Evans explained that until Teacher Lacy McHenry is able to file a reinstatement with the court and it is approved, she cannot be working at any licensed facility. LPM Charles also explained that Teacher Lacy McHenry will be disassociated from all licensed facilities in the Guardian system.

Teacher Lacy McHenry was asked to try her best to file for the reinstatement as soon as possible. Once the appeal is processed through the head office in Sacramento then the Oakland South East Regional Office will be notified. A copy of the Court Case document was provided to Teacher Lacy McHenry and one copy was given to Human Resources Officer Deborah Middleton. Chief Human Resources Officer Deborah Middleton mentioned a letter of resignation will go into effect today 10/26/2022 until the appeal is resolved.

A copy of this report was provided and contact information for Regional Office Manager and Licensing Program Manager was provided. This report shall remain on file for 3 years.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
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