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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423732
Report Date: 02/04/2025
Date Signed: 02/04/2025 02:43:40 PM

Document Has Been Signed on 02/04/2025 02:43 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:WILMA CHAN CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013423732
ADMINISTRATOR/
DIRECTOR:		LUIS ARENASFACILITY TYPE:
850
ADDRESS:7980 PLYMOUTH STREETTELEPHONE:
5105356949
CITY:OAKLANDSTATE: CAZIP CODE:
94621
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 13DATE:
02/04/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Nicole GibbsTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On 2/4/25, at 12:45PM, Licensing Program Analysts (LPAs) Catherine Fernandes and Mario Caro arrived on unannounced on a Case Management inspection regarding two incidents that were self reported to Community Care Licensing. LPAs met with Director Nicole Gibbs and Area Supervisor Lucy Arrizon. Present in care were 13 preschoolers with an additional three staff members.

On 1/8/25, a child had left the classroom unsupervised and walked in to the Director's office. After interviews and reviewing documents related to the incident, it is unclear as to how the child was discovered. Director stated the child was without supervision for maybe a minute.
On 1/23/25, a child was left outside in the gated playground, unsupervised while transitioning back into the classroom. Staff was unaware of the missing child until the child knocked on the door and was brought back to the classroom by a staff member. Director stated that while reviewing videos the child was without supervision for about two minutes at most.

LPAs informed Director Gibbs that this report dated 2/4/25 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPAs informed the Director to provide a copy of this licensing report dated 2/4/25 that documents any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Notice of site visit must be posted for 30 days.

Exit interview conducted Director. Report, Appeal Rights, Civil penalty, Notice of Site visit and LIC9224 provided. See 809D for deficiency cited.

Mayla MendozaTELEPHONE: (510) 873-6408
Catherine FernandesTELEPHONE: (510) 725-7002
DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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 02/04/2025 02:43 PM - 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: WILMA CHAN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013423732

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/05/2025
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision- 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.
This requirement has not been met as
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The center will schedule an all staff training regarding supervision. The training will include a plan to ensure all children are supervised at all times, the names of attending staff and the agenda for the meeting. The center will send the date of the all staff training to CCL by POC date.
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evidenced by: Based on interviews there were two incidents where a child was left with no supervision which is an immediate safety risk to children in care.
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A civil penalty has been assessed in the amount of $500.


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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.
Mayla MendozaTELEPHONE: (510) 873-6408
Catherine FernandesTELEPHONE: (510) 725-7002

DATE: 02/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/04/2025

LIC809 (FAS) - (06/04)
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