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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408267
Report Date: 11/03/2022
Date Signed: 11/03/2022 04:21:10 PM


Document Has Been Signed on 11/03/2022 04:21 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:FIRST BAPTIST HEAD START-LONE TREEFACILITY NUMBER:
073408267
ADMINISTRATOR:PATRICIA TAYLORFACILITY TYPE:
850
ADDRESS:1931 MOKELUMNE DRIVETELEPHONE:
(925) 664-9323
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY:57CENSUS: 11DATE:
11/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Felicia ArandaTIME COMPLETED:
04:30 PM
NARRATIVE
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On 11/03/2022 at 10:00 AM, Licensing Program Analyst (LPA) Christina Watts conducted an Case Management inspection at The YMCA of the East Bay - Lone Tree (formally known as First Baptist Head Start - Lone Tree). LPA met with Center Director, Felicia Aranda and explained purpose of today's inspection. Director took LPA on a tour of the facility which is in a portable on the campus of Lone Tree Elementary. During inspection, there were 11 children in care and 3 staff in classroom 1. There are currently 15 children enrolled. The hours of operations are Monday - Friday 7 AM - 5:30 PM.

LPA Watts is responding to an unusual incident that was submitted to licensing on 10/19/2022. On 10/18/2022, around 10:00 AM, The Director stated she was preparing the kitchen for the food service to deliver food for the facility. Director said at this time, she did not have a cook and was preparing meals for the facility. Director stated there was a plastic bin with dirty dishes that was placed on the counter. S3 stated they had put the plastic bin on the counter to get cleaned. The Director stated she was clearing space for the food delivery and placed the plastic bin on the back burner of the stove. Director stated the stove was not turned on when she placed the plastic bin on the stove. The Director stated there is usually a light on the stove that indicates the stove is turned on. The Director said she walked away from the kitchen area to go back to her desk which is located in classroom 1. S4 stated they looked over to their left and seen a fire. S4 stated they started to yell "Fire". S2 stated they were walking into classroom 2 and heard S4 yell "Fire" and went back into classroom 1 to tell staff there was a fire. The Director stated she told staff to leave the building with the children. Multiple interviews concluded 2 staff member got the children to line up and leave out the front door near classroom 2, near the fire in the kitchen. The Director stated that the staff and children had to exit through the front door because the gate in the back of the facility that gives access to Lone Tree Elementary's yard was inoperable. S2 stated that they was trying to use the fire extinguisher to stop the flames but S2 was using the fire extinguisher incorrectly. So S2 stated that S4 came to assist S2 with the fire extinguisher and successfully stop the fire.

*CONT ON PAGE 2*
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


Document Has Been Signed on 11/03/2022 04:21 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: FIRST BAPTIST HEAD START-LONE TREE
FACILITY NUMBER: 073408267

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2022
Section Cited

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101223 Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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This requirement has not been met as evidenced by: Based on interviews, facility did not comply with the section cited above when children had to walk by fire in kitchen when evacuating facility which poses an immediate risk to the health, safety or personal rights of children in care.
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Type A
11/04/2022
Section Cited

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101223 Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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This requirement has not been met as evidenced by: Based on interviews, facility did not comply with the section cited above when the fire alarm did not turn on until after evacuation which poses an immediate risk to the health, safety or personal rights of children in care.
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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) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4


Document Has Been Signed on 11/03/2022 04:21 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: FIRST BAPTIST HEAD START-LONE TREE
FACILITY NUMBER: 073408267

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2022
Section Cited

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101238 Buildings and Grounds (c)All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction. This requirement is has not been met as evidenced by:
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Based on observation and interview, the facility did not comply with the section cited above when gate was not operable when children and staff had to evacuate due to fire which poses an potential risk to the health, safety or personal rights of children in care.
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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) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4


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-LONE TREE
FACILITY NUMBER: 073408267
VISIT DATE: 11/03/2022
NARRATIVE
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*PAGE 2*

The Director stated she called 911 and then her supervisor. Multiple interviews stated that the fire alarm did not go off until children and staff were out of the building. The Director stated that P1 and M1 were walking towards the facility to see if facility was conducting a fire drill or if it was a fire. The Director stated she told P1 and M1 that there was an actually fire in the facility. The Director said that M1 went into the facility. The Director stated M1 said the stove was on and M1 turned off the stove. The Director stated that the Fire Department showed up and unplugged the stove as well as moved the stove. The Director also said that the Fire Department moved the plastic bin from the stove to the cart outside. The Director stated on 10/19/2022, the facility had started repairs on gate and had the stove replaced. The Director stated by 10/20/2022, facilities has repaired the gate. LPA went to the gate with the Director to see if the gate opens. LPA observed that they gate opens easily however the gate is does not close on it's on without force. The Director stated that the top bolt of the gate has rusted. The gate has been inoperable since July 2022. The Director stated since the facility belongs to the School District, they have to wait for the gate to be completely fixed and operable.

The facility failed in complying with the California Code of Regulations, Title 22 by not providing a healthy and safe environment by the children passing the fire to evacuate the facility due to the gate in the back not being operable and the fire alarm not being operable until after the staff and children have evacuated the facility.


LPA Christina Watts informed Director Felicia Aranda that this report dated 11/03/22 with 2 Type A citations which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Christina Watts informed the Director Felicia Aranda to provide a copy of this licensing report dated 11/03/22 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

LPA Christina Watts informed Director Felicia Aranda that this report dated 11/03/2022 documents a Type B citation. Type B citation(s) are a potential risk(s) to the health, safety, or personal rights of children in care.

*SEE LIC 809D FOR DEFICIENCIES*

Exit interview conducted and report was reviewed with the Director Felicia Aranda. Director signed the report acknowledging receipts of documents. A notice of site visit was given and must remain posted for 30 consecutive days


SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4