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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406634
Report Date: 12/15/2021
Date Signed: 12/20/2021 04:23:57 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:CHILD DAY SCHOOL, LLC - SAN RAMONFACILITY NUMBER:
073406634
ADMINISTRATOR:VALDES, RUTHFACILITY TYPE:
840
ADDRESS:18868 BOLLINGER CANYON RDTELEPHONE:
(925) 820-2515
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:20CENSUS: 8DATE:
12/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jillian MillerTIME COMPLETED:
01:35 PM
NARRATIVE
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On December 15, 2021 at 9:00am, Licensing Program Analyst (LPA) Julia Placencia conducted a case management inspection while at the facility for another reason. LPA met with interim director Jillian Miller and assistant director Gabriela Herrera. There 8 children and an additional 2 staff members present.

An unusual incident occurred at the facility on 11/30/2021 which resulted in a child leaving his classroom alone without staff’s knowledge. The incident was not reported to Licensing as required.

Regulation cited today:

101212(d)(1)(C) Reporting Requirements –

(d)Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.


(1) Events reported shall include the following:
(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.

See 809D for deficiencies cited today. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

Exit interview conducted with interim director Jillian Miller and copy of report provided. Notice of Site Visit provided and must be posted for 30 days.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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: CHILD DAY SCHOOL, LLC - SAN RAMON
FACILITY NUMBER: 073406634
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/22/2021
Section Cited

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101212(d)(1)(C) Reporting Requirements -
(d)Upon the occurrence, during the operation of the child care center...a report shall be made to the Department by telephone or fax within the Department's next working day... In addition, a written report...shall be submitted to the Department within seven days following the occurrence....
(1) Events reported shall include the following:
(C) Any unusual incident or child absence
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(1) Events reported shall include the following:
(C) Any unusual incident or child absencethat threatens the physical or emotional health or safety of any child.
This requirement is not met as evidenced by: Based on interview and record review, an unusual incident occured that was not reported to licensing. This poses a potential health and safety, and personal rights risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2021
LIC809 (FAS) - (06/04)
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