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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420469
Report Date: 02/24/2020
Date Signed: 02/24/2020 10:50:35 AM

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:THOMPSON, SANDARAFACILITY NUMBER:
013420469
ADMINISTRATOR:THOMPSON, SANDARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 635-3139
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:14CENSUS: 4DATE:
02/24/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Sandara ThompsonTIME COMPLETED:
11:00 AM
NARRATIVE
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A Case Management – Deficiencies inspection was conducted by LPA Lisa Dyer. Present was the licensee, 1 fingerprint cleared assistant, and 4 day care children.

A review of staff records indicates that all facility staff or other persons who require Caregiver Background Checks have received criminal record and child abuse index clearances or exemptions except Lahoma Jackson, who was employed at the facility.

The attached Type A deficiency 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 currently in care at the facility and to parents/guardians of children enrolled at the facility during the next 12 months.

An exit interview was conducted. All of the licensee’s questions were answered.

Licensee was provided a copy of their appeal rights and the signature on this form acknowledges receipt of these rights. Licensee was also given a copy of Form 421BG – Civil Penalty Assessment – Caregiver Background Check.

Site visit notice must be posted for 30 days,

SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2020
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: THOMPSON, SANDARA
FACILITY NUMBER: 013420469
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/24/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/25/2020
Section Cited

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department…or transfer…the facility.
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This requirement was not met as evidenced by interview and record review. Licensee's employee Lahoma Jackson was not fingerprinted and associated to the facility prior to working with children. This poses an immediate health risk to the Health and Safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Phyllis DyerTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2020
LIC809 (FAS) - (06/04)
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