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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013418973
Report Date: 01/30/2024
Date Signed: 01/30/2024 03:48:26 PM


Document Has Been Signed on 01/30/2024 03:48 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:LEARNING TREE, THEFACILITY NUMBER:
013418973
ADMINISTRATOR:COLGAN, JENNAFACILITY TYPE:
850
ADDRESS:34050 PASEO PADRE PKWYTELEPHONE:
(510) 791-6161
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:104CENSUS: 34DATE:
01/30/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Katelyn KellyTIME COMPLETED:
04:00 PM
NARRATIVE
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On 01/30/24 Licensing Program Analyst (LPA) Jaleesa Jackson conducted an unannounced case management deficiencies visit. LPA met with Assistant Director Katelyn Kelly. Present for the inspection were 6 staff and 31 preschool age children and 3 toddlers in care.

During record reviews and interviews, the facility did not report to the Department an unusual incidents 24 hours after they occurred. A child was injured at the daycare and required medical treatment. LPA reviewed the reporting requirements regulation with Assistant Director.

See 809-D for deficiencies cited during today's inspection.

Exit interview conducted with Assistant Director Katelyn Kelly and appeal rights provided.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Jaleesa JacksonTELEPHONE: (510) 368-0021
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2024
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 2


Document Has Been Signed on 01/30/2024 03:48 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: LEARNING TREE, THE
FACILITY NUMBER: 013418973

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2024
Section Cited
CCR
101212(d)(1)(B)

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 Reporting Requirements 101212(d)(1)(B)during the operation of the child care center of any of the events a report shall be made to the Department by telephone or fax within the Department's next working day... Events reported shall include the following: Any injury to any child that requires medical treatment.
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Director and Assistant Directors will watch the "Child Care Reporting Requirements" at www.ccld.childcarevideos.org. Director and Assistant Directors will each create a written statement explaining when and how an event should be reported to CCLD and email statements to LPA Jackson by POC date.
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This requirement is not met as evidenced by:

Based on interview and record review, the licensee did not comply with the section cited above as the facility did not report an usual incident where a child required medical treatment.
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jaleesa.jackson@dss.ca.gov
Director will also send in Unusual incidents reports LICfor the three incidents.

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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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Jaleesa JacksonTELEPHONE: (510) 368-0021
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2