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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420589
Report Date: 01/21/2020
Date Signed: 01/21/2020 02:07:48 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:A.U.S.D.- WOODSTOCK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013420589
ADMINISTRATOR:HUNT, VIRGINIAFACILITY TYPE:
850
ADDRESS:500 PACIFIC AVENUETELEPHONE:
(510) 748-4001
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:120CENSUS: 77DATE:
01/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Virginia HuntTIME COMPLETED:
02:15 PM
NARRATIVE
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LPA Dayna Collier met with Program Director Virginia Hunt for a case management inspection as a result of receiving an unusual incident report. An incident occurred when a staff member attempted to transition a child from the playground to the bathroom. As the staff member was locking the gate behind her, the child began to run away from the staff member. The gate at the end of the walkway leading to the parking lot was opened. Although the staff member tried to catch the child, the child ran through that gate, through the parking lot and into the middle of the street. The staff member was not able to stop the child from running but attempted to gain control of the situation with her attempt to stop traffic. Once the child ran back to the sidewalk, the staff member was able to gain control and return the child to the classroom. The child's parent was informed of the incident.

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 parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

An exit interview was conducted and the report was discussed. Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.

A SITE VISIT NOTICE WAS POSTED BY PROGRAM DIRECTOR.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020
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: A.U.S.D.- WOODSTOCK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013420589
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2020
Section Cited

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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidenced by report review and interviews.
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This poses an immediate risk to the health and safety of children in care.
THE GATES WERE OPENED WHICH ALLOWED A CHILD ACCESS TO THE PARKING LOT AND THE PUBLIC STREET.
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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: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:
DATE: 01/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/21/2020
LIC809 (FAS) - (06/04)
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