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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420589
Report Date: 11/09/2023
Date Signed: 11/09/2023 12:36:08 PM


Document Has Been Signed on 11/09/2023 12:36 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
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: 87DATE:
11/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Virginia HuntTIME COMPLETED:
12:40 PM
NARRATIVE
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On November 9, 2023, Licensing Program Analyst (LPA) Catherine Fernandes conducted an unannounced case management in regards to a self reported unusual incident sent to the Oakland Regional Office.


On October 17th, 2023, there was an incident where a child was observed alone in the play area without supervision. A teacher that works for Alameda Unified School District observed the child alone in the sand box. The teacher then brought the child back to the classroom.

There will be a Type A citation issued for the incident. LPA informed Director Virginia Hunt to post and provide a copy of this licensing report dated November 9th, 2023 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 next 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.

Exit Interview conducted.
Report and Appeal Rights reviewed and provided to Director
The Notice of Site Visit must remain posted for 30 days.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023
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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Document Has Been Signed on 11/09/2023 12:36 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
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: 11/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/10/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision- No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement has not
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The center will providea date for an all staff training in regards to supervison. The Director will come up a system for all teachers during trainsition times to ensure all children are accounted for then send to CCL by POC.
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been met as evidence by: Based on interviews a child was left alone in the play yard which is an immediate risks to children in care.
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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: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023
LIC809 (FAS) - (06/04)
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