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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013421349
Report Date: 10/06/2021
Date Signed: 10/06/2021 05:13:08 PM

Document Has Been Signed on 10/06/2021 05:13 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:KIDS KONNECT PRESCHOOLFACILITY NUMBER:
013421349
ADMINISTRATOR:STINSON, IVYFACILITY TYPE:
850
ADDRESS:8800 FONTAINE STTELEPHONE:
(510) 569-5437
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
10/06/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Ivy StinsonTIME COMPLETED:
05:30 PM
NARRATIVE
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LPA Lisa Dyer and LPM Loretta Dyson met with Director Ivy Stinson for a Case Management Inspection. Present today is 9 preschoolers, 2 staff members, and the Director. During the course of an investigation conducted by the Investigations Branch, employee Kellie Harris’ criminal record background check has not been cleared. She also is not associated to the facility.

Kellie Harris has been present and caring for children over 30 days.

The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post 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. All parents/guardians must sign an acknowledgement form of proof of receiving this report (LIC 9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing. Assembly Bill 633 Fact Sheet was given and discussed with the licensee.

Exit interview was conducted and the report was discussed. Licensee was provided a copy of their appeal rights. Notice of Site Visit must be posted for 30 days.

SUPERVISORS NAME: Phyllis Dyer
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2021
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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Document Has Been Signed on 10/06/2021 05:13 PM - It Cannot Be Edited


Created By: Phyllis Dyer On 10/06/2021 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: KIDS KONNECT PRESCHOOL
FACILITY NUMBER: 013421349

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/07/2021
Section Cited
CCR
101170(e)(1)

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Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: obtain a California clearance or a criminal record exemption as required by the Department
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Licensee understands that as of the close of business today, Kellie Harris cannot return to work at the facility until fingerprint cleared and associated to the facility. She has worked for the facility continuously for the last 30 days.
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This requirement was not met as evidenced by record review, observation and licensee interview. Kellie Harris is not cleared and associated to the facility. This poses an immediate risk to the health and safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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:Phyllis Dyer
LICENSING EVALUATOR NAME:Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2021


LIC809 (FAS) - (06/04)
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