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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408220
Report Date: 09/29/2022
Date Signed: 09/29/2022 03:52:39 PM


Document Has Been Signed on 09/29/2022 03:52 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:
09/29/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:BLANCA FAJARDO-CARDENASTIME COMPLETED:
04:00 PM
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LICENSING PROGRAM ANALYST TASHA ALEXANDER MET TODAY WITH CENTER DIRECTOR BLANCA FAJARDO-CARDENAS TO DISCUSS A SELF REPORTED UNUSUAL INCIDENT. THE FACILITY REPORTED INCIDENT THAT HAPPENED ON 8/17/22 AT LUNCHTIME, A CHILD APPEARED TO CHOKE OFF OF FOOD IN HIS/HER MOUTH. PER DIRECTOR, STAFF WAS PRESENT AND TOOK THE NECESSARY STEPS TO HELP THE CHILD. NO INJURIES WERE REPORTED. PARENTS WERE NOTIFIED. THE CHILD REMAINED IN CARE AFTER THE INCIDENT ON THIS DAY.

BASED ON INTERVIEWS/OBSERVATIONS, THERE ARE NO DEFICIENCIES CITED TODAY.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
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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