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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423734
Report Date: 10/16/2024
Date Signed: 10/16/2024 04:18:00 PM

Document Has Been Signed on 10/16/2024 04:18 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:OUSD-KAISER EARLY CHILDHOOD CENTERFACILITY NUMBER:
013423734
ADMINISTRATOR/
DIRECTOR:		HERRERA, CHRISTIEFACILITY TYPE:
850
ADDRESS:25 S. HILL CTTELEPHONE:
(510) 549-4900
CITY:OAKLANDSTATE: CAZIP CODE:
94618
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: DATE:
10/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Alicia EutslerTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On 10/16/2024 at 1:30 PM Licensing Program Analyst (LPA), A. Curry conducted an unannounced case management visit to follow up on a self-reported unusual incident where a child was found in the bathroom crying. LPA met with the Site Principal, Alicia Eutsler, to discuss the purpose of today's visit. LPA toured the facility, made observations, and conducted interviews with staff. The interviews revealed that a child left the classroom without staff knowing and was found in the hallway bathroom adjacent to the classroom (See 809D). A staff stated there may have been an OUSD staff , who is not apart of the preschool program, in the bathroom with the child, but was unsure. Interviews also stated the child seemed visible upset as well.

The incident occurred on 09/24/2024, but was not reported to Licensing until 10/08/2024 (See 809D). The Site Principal was advised to report all unusual incidents by the next working day and submit the LIC 624 to the Oakland Regional office within 10 days of the incident occurring. The LIC 624 can be emailed to oaklandchildcarero@dss.ca.gov.

The following deficiencies are being cited:
  1. 101229(a)(1) Responsibility for Providing Care and Supervision
  2. 101212(d)(1)(C) Reporting Requirements


Notice of site visit form was given and must remain posted for 30 days.

Exit interview conducted, appeal rights were given, and report was reviewed with Site Prinipal, Alicia Eutsler.
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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 10/16/2024 04:18 PM - It Cannot Be Edited


Created By: Ashley Curry On 10/16/2024 at 02:53 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: OUSD-KAISER EARLY CHILDHOOD CENTER
FACILITY NUMBER: 013423734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2024
Section Cited
CCR
101229(a)(1)

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101229Responsibility for Providing Care and Supervision(a)The licensee shall provide care and supervision..to meet the children's needs.(1)No child(ren) shall be left without the supervision of a teacher at any time...

This requirement was met as evidence by:
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By 10/30/2024 email LPA a written plan on how the facility will ensure they stay in compliance.
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Based on interviews and record review, the facility did not comply with the section cited above, by not ensuring each child is properly supervised by a preschool staff, which poses a potential risk to the health safety, and personal rights of children in care.
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Type B
10/30/2024
Section Cited
CCR101212(d)(1)(C)

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101212 Reporting Requirements(d) Upon the occurrence...a report shall be made to the Department...within the Department's next working day.... In addition, a written report...shall be submitted to the Department within seven days following the occurrence of such event.(1) Events reported shall include the following:(C)ny unusual incident or child absence that threatens the physical or emotional health or safety of any child.
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By 10/30/2024 email LPA a written statement that the facility will comply with this regulation.
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This requirement was not met as evidence by:
Based on interviews and record review the licensee did not comply with the section cited above by ensure they report all unusual incidents within the next working day, which poses a potential risk to the health and safety 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.
SUPERVISOR'S NAME:Monica Mathur
LICENSING EVALUATOR NAME:Ashley Curry
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


LIC809 (FAS) - (06/04)
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