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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423059
Report Date: 07/11/2024
Date Signed: 07/11/2024 10:23:48 AM


Document Has Been Signed on 07/11/2024 10:23 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:ORKIDZ PRESCHOOLFACILITY NUMBER:
013423059
ADMINISTRATOR:MAHTA MARASHIFACILITY TYPE:
850
ADDRESS:1370 MARIN AVETELEPHONE:
(510) 926-7747
CITY:ALBANYSTATE: CAZIP CODE:
94706
CAPACITY:58CENSUS: DATE:
07/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Sheila KhorasaniTIME COMPLETED:
10:45 AM
NARRATIVE
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On Thursday, 7/11/24, Licensing Program Analyst (LPA), B.Crass arrived at the facility for an unannounced visit regarding an unsubstantiated complaint. LPA met with Director Sheila Khorasani to explain the purpose of today’s visit. During the investigation of the complaint, it was revealed that the licensee did not comply with reporting requirements (See 809-D for deficiency cited).

Exit interview conducted, appeal rights were given, notice of site visit was given, and report was reviewed with the Director, Sheila Khorasani.
SUPERVISOR'S NAME: Monica MathurTELEPHONE: (510) 365-5196
LICENSING EVALUATOR NAME: Brittany CrassTELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024
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 2


Document Has Been Signed on 07/11/2024 10:23 AM - 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: ORKIDZ PRESCHOOL
FACILITY NUMBER: 013423059

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2024
Section Cited
CCR
101212(d)(1)(C)

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Upon the occurrence, during the operation of the child care center... a report shall be made to the Department… (1) Events reported shall include the following: (D) Any suspected physical or psychological abuse of any child. This requirement is not met as evidenced by:
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By 7/16/24, the licensee and the director will watch the Reporting Requirements video on CCLD’s website: https://ccld.childcarevideos.org/child-care-center-operators/child-care-reporting-requirements/ and will email LPA signed forms acknowledging that they have ...
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Based on interview and record review, the licensee did not comply with the section cited above by not reporting to licensing, an incident where a parent was suspecting psychological and physical abuse to a child, by a teacher, which poses a potential health, safety or personal rights risk to persons in care.
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watched the video and understand CCLD’s reporting requirements.

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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: Monica MathurTELEPHONE: (510) 365-5196
LICENSING EVALUATOR NAME: Brittany CrassTELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2