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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423732
Report Date: 05/28/2025
Date Signed: 05/28/2025 01:50:35 PM

Document Has Been Signed on 05/28/2025 01:50 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:
(510) 535-6949
CITY:OAKLANDSTATE: CAZIP CODE:
94621
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 18DATE:
05/28/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Nicole GibbTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 05/28/2025 at 9:30 AM, Licensing Program Analyst (LPA) Christina Watts conducted a Case Management inspection at Wilma Chan Child Development Center. LPA met Director, Nicole Gibbs and explained the purpose of this visit. During today's visit, Director stated there were 18 preschool children in care with 3 teachers in 1 classroom. Director stated there are 20 preschool children enrolled. All staff caring and supervising children have Criminal Record Clearance.

LPA is following up on a self reported unusual incident. On 03/28/2025 around 11:00 AM, 20 preschool children with 4 staff were outside, playing on the play yard. S1 stated 2 preschool children needed to go inside and use the bathroom as well as lunch time was near. S1 stated they told S2 and S3 they were taking 8 preschool children inside to wash their hands and sit at the table for lunch. S2 stated the had 6 children were lined up and ready to come inside when 1 preschool child ran to the line. S2 stated they took 7 preschool children inside to wash their hands and sit at the table. S2 stated they went back outside to tell S3 they had 5 children outside. S2 stated S3 said okay. S2 stated S1 counted the children inside and they had 15 preschool children inside the classroom. S1 stated they seen 1 child come in with S3 and S3 then went back outside. S1 stated they seen S4 come in with 2 preschool children and S4 goes back outside. Both S1 and S2 stated that S3 and S4 came inside with one more preschool child and S3 had said this is 20. S1 and S2 stated that C1 came inside the classroom after all staff and children were inside the classroom. Staff stated C1 was smiling when C1 came inside the classroom and was ready to eat. C1 was left outside, unsupervised for about 1-2 minutes. California code of regulations, Title 22 states children cannot be left unsupervised at any time. The facility is out of regulation with California Code of Regulation, Title 22.

*CON'T ON PAGE 2*
NAME OF LICENSING PROGRAM MANAGER: Sherelle Johnson
NAME OF LICENSING PROGRAM ANALYST: Christina Watts
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
VISIT DATE: 05/28/2025
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*PAGE 2*

LPA Christina Watts informed Director Nicole Gibbs and Education Manager Alejandra Thompson that this report dated 05/28/2025 with 1 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.

Furthermore, LPA Watts informed the Director Nicole Gibbs and Education Manager Alejandra Thompson to provide a copy of this licensing report dated 05/28/2025 that documents any Type A citation(s) 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.

LPA Christina Watts assessed a Civil Penalty of $250.00 for a repeat violation within a 12 month period in accordance with the California Code of Regulations, Title 22.

LPA reminded facility that waivers that were received from licensing are required to be posted.

During today's inspection, there were no violations observed.

Exit interview conducted and report was reviewed with the Education Manager, Alejandra Thompson. A Notice of Site Visit was given and must remain posted for 30 consecutive days.

NAME OF LICENSING PROGRAM MANAGER: Sherelle Johnson
NAME OF LICENSING PROGRAM ANALYST: Christina Watts
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/28/2025 01:50 PM - It Cannot Be Edited


Created By: Christina Watts On 05/28/2025 at 12:58 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: WILMA CHAN CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013423732

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/28/2025
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement has not been...
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Facility wrote an corrective action plan on how they are coming back into compliance. LPA received statement today 05/28/2025 and will clear citation today.
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met as evidenced by: Based on interviews, the licensee did not comply with the section cited above when C1 was left unsupervised for 1-2 minutes which poses an immediate risk to the health, safety or personal rights of 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.
Sherelle Johnson
NAME OF LICENSING PROGRAM MANAGER:
Christina Watts
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/28/2025


LIC809 (FAS) - (06/04)
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