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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416835
Report Date: 02/29/2024
Date Signed: 02/29/2024 01:40:35 PM


Document Has Been Signed on 02/29/2024 01:40 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:KIDANGO - CARLSON CENTERFACILITY NUMBER:
013416835
ADMINISTRATOR:AL BAKER, AALYAFACILITY TYPE:
850
ADDRESS:1301 MOWRY AVENUETELEPHONE:
(510) 608-4841
CITY:FREMONTSTATE: CAZIP CODE:
94538
CAPACITY:32CENSUS: 19DATE:
02/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Michael HenryTIME COMPLETED:
01:50 PM
NARRATIVE
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On February 29th, 2024 at approximately 10:20am, Licensing Program Analyst (LPA) April Wright conducted a Case Management visit and met with Center Director Michael Henry. LPA conducted a health and safety inspection. Present today were 19 preschool age children and 4 staff personnel. The purpose of today's visit is to follow up to an unusual incident report submitted by the facility regarding a lack of supervision involving a day care child.

Per the incident report received via phone from the Center Director, it stated that, "During transition time between lunch and nap time. Some kids were brushing their teeth, other kids were getting ready for nap time. Teacher Chao Ping Guan was helping supervise children brushing their teeth. Teacher Aide Janie Bosch was helping children get ready for nap while I was cleaning off the tables. Teacher Guan noticed C1 walk past her and thought she was going to me (Director). Teacher Guan noticed that she was not with me so we redirected supervision roles and Ms. Guan went into my office and found C1 under my desk. Director believes that she was unsupervised for approximately 30 seconds - no more than one minute."

Center Director stated on LIC624 that the C1 was found under a table in the Director's office and not the desk as previously reported over the phone. Director also stated that one of the staff members Teacher Chao Ping Guan that was present during the incident was not present during today's inspection.

LPA interviewed staff that were present at the facility and the Center Director as well as C1 regarding the incident. LPA attempted to interview C1, however was unsuccessful due to language barrier (Farsi) and understanding of English language.

Based on the Unusual Incident report received and staff interviews, this facility is being issued a Type A Violation today and assessed a $500.00 civil penalty due to lack of supervision on the attached LIC809D. This violation posed an immediate risk to the health, safety, or personal rights of children in care. LPA informed Center Director that this report dated 2/29/2024 which documents one Type A citation shall be posted for 30 consecutive days. See LIC809C for continuance.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KIDANGO - CARLSON CENTER
FACILITY NUMBER: 013416835
VISIT DATE: 02/29/2024
NARRATIVE
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LPA also informed the center director to provide a copy of this licensing report dated 2/29/2024 that documents a Type A citation 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), must be placed in the child's file for verification.

Notice of site visit was given and must remain posted for 30 days. Report read and appeal rights given to Center Director Michael Henry.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:

DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/29/2024 01:40 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: KIDANGO - CARLSON CENTER
FACILITY NUMBER: 013416835

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/29/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision (a) 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.
This was evidenced by:
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Center Director will conduct training for staff on Supervision of children in care. POC is due on 3/1/24.
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C1 was unsupervised, left classroom and was found in directors office under staff table, which posed an immediate risk to the health, safety, or personal rights of children in care. A civil penalty of $500 is being assessed for absence of supervision.
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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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: April WrightTELEPHONE: (510) 542-4257
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024
LIC809 (FAS) - (06/04)
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