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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070205112
Report Date: 07/13/2022
Date Signed: 07/13/2022 03:41:20 PM


Document Has Been Signed on 07/13/2022 03:41 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:POLLACK, CHRISTINAFACILITY NUMBER:
070205112
ADMINISTRATOR:POLLACK, CHRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 525-6775
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:12CENSUS: 11DATE:
07/13/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Christina PollackTIME COMPLETED:
03:45 PM
NARRATIVE
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On 7/13/22 at 1:30 PM Licensing Program Analyst (LPA) Michelle Sutton met with Christina Pollack to conduct a Case Management inspection to present the findings from an investigation conducted by Investigation Bureau (IB). An Unusual Incident report was received at the CCLD office on 11/22/21.

LPA spent an extensive amount of time to discus investigation allegations.

The following technical assistance and deficiency were (See LIC 809-D.) cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Christina Pollack.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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 07/13/2022 03:41 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: POLLACK, CHRISTINA
FACILITY NUMBER: 070205112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2022
Section Cited

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102423 Personal Rights (a) Each child receiving services from a family child care home so[...] but are not limited to, the following (1) To be treated with dignity [....] relationship with staff and other persons.This requirement is not met as evidence by;
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Based on IB investigation, it was confirmed that daycare child was accidentally touched inappropriately by licensee’s husband. Although it seemed to be unintentionally, the child was touch in an inappropriate area of the body. This is a potentially risk to Health and Safety or Personal Rights risk to persons 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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
LIC809 (FAS) - (06/04)
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