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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408220
Report Date: 07/13/2022
Date Signed: 07/13/2022 05:20:45 PM


Document Has Been Signed on 07/13/2022 05:20 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:S.S.U.C.-CESAR CHAVEZ CHILD DEVELOPMENT CENTERFACILITY NUMBER:
073408220
ADMINISTRATOR:CRUZ, JACQUELINEFACILITY TYPE:
850
ADDRESS:1187 MEADOW LANETELEPHONE:
(925) 798-1011
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY:142CENSUS: DATE:
07/13/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:LUCY ARRIZONTIME COMPLETED:
05:30 PM
NARRATIVE
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LICENSING PROGRAM ANALYST TASHA ALEXANDER MET WITH EDUCATION MANAGER LUCY ARRIZON FOR A CASE MANAGEMENT FOLLOW UP REGARDING AN UNUSUAL INCIDENT THAT WAS REPORTED ON 3/3/22. UPON RECEIPT OF THAT INCIDENT REPORT, THIS DEPARTMENT'S INVESTIGATION BUREAU HAS CONDUCTED AND COMPLETED AN INVESTIGATION AND DETERMINED THAT THE THERE WAS EVIDENCE TO INDICATE THAT THE FACILITY WAS OUT OF COMPLIANCE.

PLEASE SEE THE ATTACHED 809-D FOR THE TYPE A DEFICIENCY

THE LIC 9224 ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS HAS BEEN GIVEN AND EXPLAINED. A COPY OF THIS REPORT MUST BE GIVEN TO EACH DAY CARE CHILD'S PARENT/GUARDIAN BY THE NEXT BUSINESS DAY AND THE SIGNED LIC 9224 IS TO BE PUT INTO THEIR CHILD'S FILE. A COPY OF THIS REPORT MUST ALSO BE GIVEN TO ANY NEWLY ENROLLED CHILD'S PARENT/GUARDIAN FOR UP TO ONE YEAR. THIS COPY MUST BE POSTED AT THE FACILITY FOR 30 DAYS.

AN EXIT INTERVIEW WAS CONDUCTED. THIS REPORT MUST BE AVAILABLE FOR PUBLIC REVIEW FOR 3 YEARS.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
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 05:20 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: S.S.U.C.-CESAR CHAVEZ CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 073408220

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
07/14/2022
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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation
THE REQUIREMENT IS NOT MET AS EVIDENCED BY: AN IB INVESTIGATION WAS CONDUCTED AND IT WAS FOUND THAT THERE WAS ENOUGH EVIDENCE TO INDICATE THAT A CHILD WAS INAPPROPRIATELY TOUCHED BY AN ADULT MALE WHO WAS AT THE FACILITY TO WORK WITH ANOTHER CHILD.
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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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
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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