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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405697
Report Date: 11/17/2021
Date Signed: 11/17/2021 10:17:32 AM

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:FIRST BAPTIST HEAD START - EAST LELAND COURT CTR.FACILITY NUMBER:
073405697
ADMINISTRATOR:ACOSTA, RAMONAFACILITY TYPE:
850
ADDRESS:2555 EAST LELAND ROADTELEPHONE:
(925) 473-2035
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:36CENSUS: 7DATE:
11/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jajahira GallardoTIME COMPLETED:
10:20 AM
NARRATIVE
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On 11/17/21 at 9:00 AM Licensing Program Analyst (LPA) Michelle Sutton conducted a follow-up unannounced Case Management inspection about an unusual incident self reported by the Center about a child left behind in the playground. LPA met with site supervisor Jajahira Gallardo and explained the purpose of today's inspection.

LPA conducted interviews and reviewed relevant documents. It was determined that a child was left behind on the play yard while teacher was inside the classroom. Facility is being cited Type A for lack of supervision (see 809-D page).

Due to the issuance of Type A, this report has to be provided to all parents of currently and future enrolled over next 12 months. Report and deficiency page also to be posted in public view. A copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports to be signed by parent and kept in child file.

On 6/23/21 facility received a Type-B for absence of supervision of a child. Therefore, a repeat violation within 12-months is a civil penalty of $1000 issued on LIC421IM page.

Exit Interview was conducted, where this report, deficiencies, civil penalty and appeal rights was reviewed and discussed with the site supervisor Jajahira Gallardo. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: FIRST BAPTIST HEAD START - EAST LELAND COURT CTR.
FACILITY NUMBER: 073405697
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/18/2021
Section Cited

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101229 Responsibility for Providing Care & Supervision (a) The licensee shall provide care and supervision [..](1) No child(ren) shall be left without the supervision of a teacher at any time[..]. This requirement is not met as evidenced by:
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Based on observation, interviews and record reviews, site supervisor confirm that a child was left behind in the play yard. This is an immediate risk to Health and Safety or Personal Rights risk to persons in care.
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A Non-Compliance conference will be scheduled for a later date.

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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: 11/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2021
LIC809 (FAS) - (06/04)
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