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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420593
Report Date: 03/29/2022
Date Signed: 03/29/2022 10:53:20 AM

Document Has Been Signed on 03/29/2022 10:53 AM - 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:ALAMEDA HEAD START- COLLEGE OF ALAMEDA HEAD STARTFACILITY NUMBER:
013420593
ADMINISTRATOR:MA, CONNIEFACILITY TYPE:
850
ADDRESS:555 RALPH APPEZZATO MEM PKWYTELEPHONE:
(510) 629-6301
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 31DATE:
03/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Julie GiesslerTIME COMPLETED:
11:00 AM
NARRATIVE
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On 03/29/2022 Licensing Program Analyst (LPA) Arminder Singh conducted an unannounced case management inspection regarding an unusual incident report that was received in the office on 12/06/2021. LPA met with the Julie Giessler.

Julie Giessler is aware that an incident occurred where a child was in classroom #4. The child was standing at the round table when a staff member noticed the child. Staff member alerted the teachers in classroom 5 who came to retrieve the child. Child was in classroom for a brief moment.

There were 5 children in attendance, and 3 teachers, in classroom 5. The classroom is a partnership classroom where some children are enrolled in both Head Start and the Alameda Unified School District, and there are staff that work for both programs who were present. On the date of incident there were two head start teachers (working for the center) were working with other children enrolled in the head start program and a school district staff member was working with the above child and another child that is enrolled with the school district. The child went thru the bathroom that adjoins classroom 4 and 5, into the empty classroom 4. The child did not go outside of the classroom/into the hallway.

The Director and Ms. Giessler immediately spoke with all head start staff and reminded them that all of the children are part of their program and their responsibility, even when the school district staff are present. Ms. Giessler also spoke with the school district staff, and her supervisor will be speaking with the supervisor for the school district staff and reminding them that they are all working together and need to provide active supervision at all times. Staff were also reminded to ensure that the bathroom doors remain closed.

A Type B deficiency was cited during this inspection. Please see 809-D page.




SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2022
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 3
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: ALAMEDA HEAD START- COLLEGE OF ALAMEDA HEAD START
FACILITY NUMBER: 013420593
VISIT DATE: 03/29/2022
NARRATIVE
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An exit interview was conducted and the report, deficiency, plan of correction, and appeal right were discussed. Julie Giessler was provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/29/2022 10:53 AM - It Cannot Be Edited


Created By: Arminder Singh On 03/29/2022 at 10:35 AM
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: ALAMEDA HEAD START- COLLEGE OF ALAMEDA HEAD START
FACILITY NUMBER: 013420593

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2022
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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Faciltiy has spoke to all staff and to close the bathroom door that leads one classroom to the other classroom at all times. Active supervision training was given to all staff members.
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This requirement was not met as evidenced by; Child was in classroom 4 without supervision for a small period of time.
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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 Dyson
LICENSING EVALUATOR NAME:Arminder Singh
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022


LIC809 (FAS) - (06/04)
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