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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415659
Report Date: 04/30/2024
Date Signed: 05/06/2024 02:26:56 PM


Document Has Been Signed on 05/06/2024 02:26 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:NIKASIA CHILD CARE CENTERFACILITY NUMBER:
013415659
ADMINISTRATOR:LEWIS, GWENDOLYNFACILITY TYPE:
830
ADDRESS:4143 MAC ARTHUR BOULEVARDTELEPHONE:
(510) 531-9130
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:8CENSUS: 3DATE:
04/30/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Gwendolyn LewisTIME COMPLETED:
12:45 PM
NARRATIVE
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On April 30, 2024 at 8:30 am Licensing Program Analysts (LPAs) Janai McClain and Catherine Fernandes met with Licensee Gwendolyn Lewis for a case management visit regarding another matter.

Upon arrival LPAs observed one aide with three infants in care, there were no qualified teachers available, causing the center to be out of ratio. LPAs explained that a qualified teacher is needed per license. The center has another component - license number 13417824 for preschoolers.

One type A deficiency is being cited during todays visit. The 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 LIC9224 (Acknowledgment of Receipt of Licensing Reports) must be signed by each parent and placed in each child's file.

Also, LPAs Janai McClain and Catherine Fernandes informed the director to provide a copy of this licensing report dated 4/30/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A copy of the LIC9224 is being provided during the inspection.


The Director gave LPAs permission to review the report with Nikita Lewis.
Exit interview conducted. Report and Appeal Rights provided to Nikita Lewis.
Notice of Site visit must remain posted for 30 days
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Janai McClainTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:
DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2024
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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Document Has Been Signed on 05/06/2024 02:26 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: NIKASIA CHILD CARE CENTER
FACILITY NUMBER: 013415659

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/01/2024
Section Cited
CCR
101416.5(b)

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Staff-Infant Ratio (b) There shall be a ratio of one teacher for every four infants in attendance. This requirement has not been met as evidenced by:
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Center will come up with a schedule to reflect a qualified teacher is present at all times within ratio limits. Center will send the plan to CCLD by proof of correction date.
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Based on observations, the licensee did not comply with the section cited above as LPAs observed one aide caring for three infants which poses an immediate risk to the health, safety or personal rights 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) 292-2724
LICENSING EVALUATOR NAME: Janai McClainTELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:
DATE: 04/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2024
LIC809 (FAS) - (06/04)
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