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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206137
Report Date: 07/21/2026
Date Signed: 07/21/2026 04:45:06 PM

Document Has Been Signed on 07/21/2026 04:45 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:OUSD - HARRIET TUBMANFACILITY NUMBER:
010206137
ADMINISTRATOR/
DIRECTOR:		REED, VONZELEFACILITY TYPE:
850
ADDRESS:800-33RD STREETTELEPHONE:
(510) 654-7890
CITY:OAKLANDSTATE: CAZIP CODE:
94608
CAPACITY: 72TOTAL ENROLLED CHILDREN: 47CENSUS: 21DATE:
07/21/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:11 PM
MET WITH:Stephanie JosephTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
NARRATIVE
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On 07/21/2026 at 2:11 PM, Licensing Program Analyst (LPA) Christina Watts conducted an Case Management Inspection regarding an alleged lack of supervision violation at OUSD - Harriet Tubman. LPA met with Compliance Coordinator, Stephanie Joseph and explained the purpose of today's inspection. During today's inspection, there were 21 preschool children with 5 staff in two classrooms. Director stated there are 47 preschool children enrolled.

LPA is following up on an self reported Unusual Incident Report submitted to licensing on 06/18/2026. LPA toured the facility, observed classrooms, conducted interviews and obtained relevant documents. Per staff interviews, around 3:20 PM, about 7-8 children were outside with S1 playing while S3 had about 6-7 children inside the classroom. S2 stated they observed S1 on their phone and not watching the children. S2 stated they went to the restroom when they heard laughing and footsteps. S2 stated when they came out the restroom, they seen C2 and C3 holding the door open. S2 stated they went to the door and that is when they seen C1 outside the facility, about to step onto the street when S2 went to get C1 from the street. S2 stated they took all 3 children back inside the classroom with S3. S2 stated they went to talk to S1 about the children being in the front of the facility alone and S1 stated they did not observe any children leave the play yard. California code of regulation, Title 22 states children are to be supervised at all times while in a daycare facility. LPA also observed that while the incident was reported within 24 hours, the Unusual Incident form (LIC 624) was not submitted within the 7 days. The facility is out of compliance with California code of regulation, Title 22.

LPA Christina Watts informed Compliance Coordinator, Stephanie Joseph. that this report dated 07/21/26 with 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. *CON'T ON PAGE 2*
Sherelle Johnson
Christina Watts
DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: OUSD - HARRIET TUBMAN
FACILITY NUMBER: 010206137
VISIT DATE: 07/21/2026
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*PAGE 2*

Furthermore, LPA Watts informed the Compliance Coordinator to provide a copy of this licensing report dated 07/21/26 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 Compliance Coordinator, Stephanie Joseph. that this report dated 07/21/2026 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 809-D FOR DEFICIENCIES*

Exit interview conducted and report was reviewed with the Compliance Coordinator, Stephanie Joseph. A Notice of Site Visit was given and must remain posted for 30 consecutive days.

NAME OF LICENSING PROGRAM MANAGER: Sherelle Johnson
NAME OF LICENSING PROGRAM ANALYST: Christina Watts
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 07/21/2026 04:45 PM - It Cannot Be Edited


Created By: Christina Watts On 07/21/2026 at 04:13 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: OUSD - HARRIET TUBMAN
FACILITY NUMBER: 010206137

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/22/2026
Section Cited
CCR
101229(a)(1)

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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...Supervision shall include visual observation. This requirement has not been
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By 07/22/2026, Compliance Coordinator stated they will submit a written statement on how facility will come back into compliance.
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met as evidenced by: Based on interviews, the licensee did not comply with the section cited above when 3 children were able to get out of the supervision of S1 when C2 and C3 were at the door and C1 was on the sidewalk alone 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.
Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:
Christina Watts
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/21/2026 04:45 PM - It Cannot Be Edited


Created By: Christina Watts On 07/21/2026 at 04:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: OUSD - HARRIET TUBMAN
FACILITY NUMBER: 010206137

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2026
Section Cited
CCR
101212(d)

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101212 Reporting Requirements (d) Upon the occurrence...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...shall be submitted to the Department within seven days following the occurrence..

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By 07/22/2026, Compliance Coordinator stated they will submit a written statement on how facility will come back into compliance.
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This requirement has not been met as evidenced by: Based on record review, the licensee did not comply with the section cited above when the facility failed to submit the LIC 624 within 7 days 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.
Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:
Christina Watts
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2026


LIC809 (FAS) - (06/04)
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