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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422027
Report Date: 02/25/2020
Date Signed: 02/25/2020 01:05:43 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:TINY TREASURES PRESCHOOLFACILITY NUMBER:
013422027
ADMINISTRATOR:SMITH, KIMBERLYFACILITY TYPE:
850
ADDRESS:1803 NORTH LOOP RDTELEPHONE:
(510) 995-2579
CITY:ALAMEDASTATE: CAZIP CODE:
94502
CAPACITY:60CENSUS: 43DATE:
02/25/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Kimberly SmithTIME COMPLETED:
01:10 PM
NARRATIVE
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LPA Dayna Collier met with Center Director Kimberly Smith for a case management inspection as a result of receiving an unusual incident report. An incident occurred when a child was left alone on the playground. Staff transitioned the children from the playground into the classroom but did not notice that one child did not cross the threshold. The door was closed and staff began to transition children to circle time. Another staff member began to transition her classroom to the yard when she observed the child standing alone. The staff member consoled the crying child and returned the child to her classroom. The child's parent was immediately informed of the incident. Per staff, the child was alone for about 60 seconds.

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 DIRECTOR.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2020
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: TINY TREASURES PRESCHOOL
FACILITY NUMBER: 013422027
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/03/2020
Section Cited

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) 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.
(1) No child(ren) shall be left without the supervision of a teacher at any time,
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except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement was not met as evidenced by report review and interviews. This poses an immediate risk to children in care.
A LIC 421IM FORM WAS GIVEN TO DIR.
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AN SUBSEQUENT VIOLATIONS IN THIS SUBSECTION MAY RESULT IN AN IMMEDIATE CIVIL PENALTY OF $1,000.

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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: 02/25/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2020
LIC809 (FAS) - (06/04)
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