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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423066
Report Date: 05/11/2022
Date Signed: 05/11/2022 03:25:10 PM

Document Has Been Signed on 05/11/2022 03:25 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:DIAMOND LITTLE PEOPLE ACADEMY LLCFACILITY NUMBER:
013423066
ADMINISTRATOR:JOHNSON, DELTRINAFACILITY TYPE:
850
ADDRESS:955 12TH STREETTELEPHONE:
(510) 788-0436
CITY:OAKLANDSTATE: CAZIP CODE:
94607
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 35DATE:
05/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:MONIQUE MOSSTIME COMPLETED:
03:45 PM
NARRATIVE
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On May 11, 2022 Licensing Program Analysts (LPAs), Melissa Domantay and Indira Loza, conducted an unannounced case management inspection due an Unusual Incident Report received on May 4, 2022. LPAs met with Director Monique Moss, and toured the full facility that is utilized by the Preschool component. . LPAs observed 3 staff and 35 children in care at the time of arrival. LPAs inspected the Preschool to ensure the Health and Safety of children in care.

During today's inspection LPAs conducted staff interviews. See 809-D for Type A deficiency.

Exit interview conducted. A copy of report and appeal rights provided to Director Monique Moss.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2022
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 05/11/2022 03:25 PM - It Cannot Be Edited


Created By: Melissa Domantay On 05/11/2022 at 03:14 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: DIAMOND LITTLE PEOPLE ACADEMY LLC
FACILITY NUMBER: 013423066

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2022
Section Cited
CCR
101223(a)(3)

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To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting;
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Facility will conduct a staff meeting and discuss children's Personal Rights will submit minutes of the meeting,and a sign-in sheet of staff who attended. Also, staff must review Personal Rights videos on the CDSS website, and submit a statement from each staff of what they learned from the video.
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or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by staff interviews. This poses an immediate health and safety risk to 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.
SUPERVISOR'S NAME:Mayla Mendoza
LICENSING EVALUATOR NAME:Melissa Domantay
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2022


LIC809 (FAS) - (06/04)
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