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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423060
Report Date: 10/12/2023
Date Signed: 10/12/2023 03:34:43 PM

Document Has Been Signed on 10/12/2023 03:34 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:SMALL SIZE BIG MIND INCFACILITY NUMBER:
013423060
ADMINISTRATOR:CHOP, MALYKAFACILITY TYPE:
850
ADDRESS:2450 PAN AM WAYTELEPHONE:
(510) 420-4567
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 102TOTAL ENROLLED CHILDREN: 75CENSUS: 53DATE:
10/12/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Malyka ChopTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Cherie Acosta and Christina Watts conducted an unannounced case management visit. LPAs met with Malyka Chop.

LPAs arrived at the facility to conduct a complaint investigation. LPAs arrived during nap time. As LPAs toured the facility it was observed that a child in the two's class was sleeping on a round wooden object that is part of the indoor play loft. The area the child was sleeping on was approximately 3 to 4 feet off the ground and did not have anything to prevent the child from falling off. This area was observed to be unsafe for sleeping. Child was removed from the play loft during the visit.

See 809-D for deficiency cited during today's inspection.

Exit interview and report reviewed with Malyka Chop.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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 10/12/2023 03:34 PM - It Cannot Be Edited


Created By: Cherie Acosta On 10/12/2023 at 02:52 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: SMALL SIZE BIG MIND INC
FACILITY NUMBER: 013423060

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2023
Section Cited
CCR
101223(a)(2)

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Personal Rights. The licensee shall ensure that each child is accorded the following personal rights:To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs
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Licensee shall develop a written plan to ensure children are always provided a safe sleeping area. Licensee shall submit a copy of this plan to CCL by 10/16/23
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This requirement was not met as evidenced by: child was sleeping on an unsafe area which is a potential 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:Sherelle Johnson
LICENSING EVALUATOR NAME:Cherie Acosta
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2023


LIC809 (FAS) - (06/04)
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