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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416346
Report Date: 08/23/2021
Date Signed: 08/23/2021 01:36:31 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:OUSD - INTERNATIONAL CDCFACILITY NUMBER:
013416346
ADMINISTRATOR:HERRERA, CHRISTIEFACILITY TYPE:
850
ADDRESS:2825 INTERNATIONAL BOULEVARDTELEPHONE:
(510) 532-7267
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY:72CENSUS: 19DATE:
08/23/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Alesia EutslerTIME COMPLETED:
01:50 PM
NARRATIVE
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Licensing Program Analysts (LPA's) Cherie Acosta and Diana Campos conducted a Case Management inspection at facility to follow up on the self reported incident that occurred on 08/09/2021. LPA met with Teacher Cintya Valdivia who guided the LPA's on a tour of the facility. LPAs later met with acting site administrator Alesia Eutsler.
During the investigation LPA's interviewed staff, and obtained copies of relevant documents. Based on inspection, interviews and documents received, it was reported that on 8/09/2021 a child exited the facility without staff's knowledge or supervision. Staff is unaware how the child exited the facility. The child was found across the street at a shopping center. The child was in the care of a police officer when found. The facility was unaware of the child's whereabouts for at least thirty minutes.

The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.


Exit interview conducted with acting site administrator Alesia Eutsler
Notice of Site visit was provided and must be posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2021
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: OUSD - INTERNATIONAL CDC
FACILITY NUMBER: 013416346
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/24/2021
Section Cited

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The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as
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specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by: child wandered away from facility without staff supervision, which poses an an immediate 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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana CamposTELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2021
LIC809 (FAS) - (06/04)
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