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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070206884
Report Date: 09/16/2019
Date Signed: 09/16/2019 12:38:58 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:LARSON'S CHILDREN CENTERFACILITY NUMBER:
070206884
ADMINISTRATOR:STEPHANIE VIERRAFACILITY TYPE:
850
ADDRESS:920 DIABLO ROADTELEPHONE:
(925) 837-4238
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY:45CENSUS: 37DATE:
09/16/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Stephanie VierraTIME COMPLETED:
12:40 PM
NARRATIVE
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LPA Dayna Collier met with Center Director Stephanie Vierra 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. Two staff members transitioned 7 children from the playground but failed to notice one child was left behind. Another older child in care saw the child through the chain link fence and informed staff that the child was alone. The two staff members inside had not missed the child's presence. Per staff, the head count was inaccurate at various intervals, causing staff to confirm to each other the wrong number of children to be accounted for. Following the incident, the child's parents were informed. Per staff, the child was alone on the playground for 3-5 minutes.

The attached type A deficiency is cited today and must be corrected. 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 the Director.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Dayna CollierTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2019
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: LARSON'S CHILDREN CENTER
FACILITY NUMBER: 070206884
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/23/2019
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, . . . Supervision shall include visual observation.
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This requirement was not met as evidenced by interviews and report review. This poses an immediate risk to children in care.
A CHILD WAS LEFT ON THE PLAYGROUND ALONE WITH STAFF'S KNOWLEDGE AND/OR OBSERVATION.
AN LIC 421IM FORM WAS GIVEN TO DIRECTOR.
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THIS PENALTY WILL CONTINUE AT $100 PER DAY UNTIL CORRECTED. ANY SUBSEQUENT VIOLATIONS OF SECTION 101229 WITHIN A 12 MONTH PERIOD WILL RESULT IN A $1,000 CIVIL PENALTY.

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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: 09/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2019
LIC809 (FAS) - (06/04)
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