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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620820
Report Date: 02/13/2020
Date Signed: 02/13/2020 01:09:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CAPC - MOUNTAIN VIEWFACILITY NUMBER:
393620820
ADMINISTRATOR:SAGUIGUIT, VANFACILITY TYPE:
850
ADDRESS:377 W. MOUNT DIABLO AVE. #20TELEPHONE:
(209) 464-4524
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:24CENSUS: 20DATE:
02/13/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cherryl Balatbat
TIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst Stacey Williams conducted a case management inspection at the facility and met with Program Manager, Cherryl Balatbat. The inspection was in regards to an Unusual Incident report that was self reported and submitted to Community Care Licensing regarding an incident that took place on February 12,2020. During today's inspection there were (20) twenty preschool children supervised by four staff.

LPA made observations of both indoor and outdoor activities during today's inspection. LPA observed children transitioning from outdoor to indoor activities, eating lunch to nap time, and children leaving the center. Each child's name was called to confirm attendance during each transition.

LPA conducted interviews with the Program Manager regarding the incident. Program Manager reported that a child was left unattended outside for approximately 30 seconds. Staff #1 transitioned children from outside into the facility and was unaware that a child was hiding outside. Program Manager stated that staff did not follow company protocol ensuring that an accurate headcount was conducted and every child was accounted for at all times. As a result staff #1 resigned on February 12, 2020 and the Center Manager was terminated from employment on today's date, February 13,2020.


One Type A Title 22 deficiency is cited on the subsequent page of this report.
Program Manager acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, Director shall post LIC 809-D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee.

LIC 9224 and Appeal Rights were provided. An exit interview was conducted and a Notice of Site Visit was posted.


SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: CAPC - MOUNTAIN VIEW
FACILITY NUMBER: 393620820
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/14/2020
Section Cited

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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time.
This requirement was not met as evidenced by: LPA Williams received a UIR stating that there had been an incident where a child
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was left outside unattended for 30 seconds. Program Manager was interviewed during today's inspection and confirmed that Staff #1 was unaware that a child was hiding outside. This poses an immediate risk to the health and safety of children in care.
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Head Start of San Joaquin will conduct staff training on February 14,2020. The Program Director and Program Manager will host a team meeting on February 14,2020 to discuss the incident and ensure that policy is followed at all times concerning supervision. Program Manager will submit the staff roster and training material to CCL by POC date-2/14/2020.

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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: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2020
LIC809 (FAS) - (06/04)
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