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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013419486
Report Date: 09/07/2022
Date Signed: 09/07/2022 11:13:10 AM


Document Has Been Signed on 09/07/2022 11:13 AM - 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:KIDANGO - AMADORFACILITY NUMBER:
013419486
ADMINISTRATOR:JACKSON, AMORRISFACILITY TYPE:
850
ADDRESS:24100 AMADOR STREETTELEPHONE:
(510) 259-2929
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY:75CENSUS: 34DATE:
09/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Sharmaine PazcoguinTIME COMPLETED:
11:30 AM
NARRATIVE
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On September 7, 2022 at approximately 10:20 AM, Licensing Program Analyst(LPA) Elimika Woods conducted an Unannounced Case Management Visit at Kidango-Amador Preschool Center. The census at time of the visit were thirty four (34) children and nine (9) additional staff members who are all fingerprint cleared and associated. LPA Woods met with the facility representative Sharmaine Pazcoguin. The purpose of the visit was to review the director's file.


LPA Woods gathered paperwork with the facility representative.
LPA Woods reviewed the director's file at 10:30 AM to verify if she was qualified. Upon review LPA Woods did not find the director's packet or a copy in her personal file


As a result of today's inspection see 809-D cited today.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative,Sharmaine Pazcoguin. Appeals right were given to the facility representative.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
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 09/07/2022 11:13 AM - 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: KIDANGO - AMADOR
FACILITY NUMBER: 013419486

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/21/2022
Section Cited

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101212(b)
Reporting Requirements. The name of the child care center director or fully qualified teacher(s) designated to act in the director’s absence shall be reported to the Department with in 10 days of a change.
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LPA was not informed that Amorris Jackson is no longer the Director. This change happened approximately 3 months ago. Facility failed to inform the Department within the required time frame.
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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: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2