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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700531
Report Date: 11/19/2021
Date Signed: 11/19/2021 01:39:36 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:KIDANGO HILLSIDEFACILITY NUMBER:
015700531
ADMINISTRATOR:NEAL, DANASIAFACILITY TYPE:
850
ADDRESS:15980 MARCELLA STREETTELEPHONE:
(510) 516-7376
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:24CENSUS: 18DATE:
11/19/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Nadine JacintoTIME COMPLETED:
01:53 PM
NARRATIVE
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On 11/19/2021, Licensing Program Analyst (LPA) Jonathan Williams arrived at the facility unannounced for the purposes of conducting an Case Management inspection in response to Unusual Incident reported to CCLD regional office via phone on 11/05/2021. Present for today's inspection was the Director, two fully qualified teachers, and eighteen preschool aged children in care.

This visit was made in response to an Unusual Incident reported to CCLD regional office via phone on 11/05/2021 in which it was reported that a child in care had escaped the facility classroom on 11/04/2021 at approximately 12:00pm and entered the quad area of Hillside Elementary School, which Kidango Hillside shares a site with. Per Director, the child was found by an administrator of Hillside Elementary School and brought the child back to the classroom.

LPA Williams reviewed children/staff files, toured the facility, and interviewed three staff members present today. Per statements made to LPA Williams by Director and both staff members present today, staff members did not see the child leave the classroom. All three staff members today stated during today's visit that they were present in the facility during the reported incident on 11/04/2021.

Type A deficiency is cited today in response to incident. See LIC809-D for citation details. Director is reminded to deliver copies of LIC9224 to parents of children in care and to all parents of children enrolled over the next 12 months. Children's roster was obtained.

Notice of Site Visit was provided and must remain posted in public view for a period of 30 days. Appeal Rights were provided to the Director and signature on this report acknowledges receipt of said rights.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: KIDANGO HILLSIDE
FACILITY NUMBER: 015700531
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/29/2021
Section Cited

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(1) No child(ren) shall be left without the supervision of a teacher at any time

This requirement was not met as evidenced by:
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Based on staff interviews, it was determined that a child in care had escaped from the facility grounds due to absence of supervision. This poses an immediate risk to the health and safety of 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: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2021
LIC809 (FAS) - (06/04)
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