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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700531
Report Date: 11/21/2023
Date Signed: 11/21/2023 09:57:07 AM

Document Has Been Signed on 11/21/2023 09:57 AM - 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KIDANGO HILLSIDEFACILITY NUMBER:
015700531
ADMINISTRATOR:NEAL, DANASIAFACILITY TYPE:
850
ADDRESS:15980 MARCELLA STREETTELEPHONE:
(510) 516-7376
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 13DATE:
11/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Irma PaijaTIME COMPLETED:
10:15 AM
NARRATIVE
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On November 21, 2023 at 8:30 AM, Licensing Program Analyst (LPA) Elimika Woods conducted a Case Management visit to the facility and met with the facility representative Irma Paija. There were 13 preschool age children in care and three (3) additional staff at the time of the inspection. The purpose of today's visit is to address an unusual incident report submitted by the facility regarding a lack of supervision incident with a day care child.

LPA Spoke with facility representative about a child that was left outside unsupervised for about five (5) minutes while transitioning from outdoor play to the classrooms. The facility representative said that the teachers did not notice the child until they heard a child crying outside.

Based on the Unusual Incident reported and interview, lack of supervision is being cited. Lack of supervision poses an immediate risk to children in care and is therefore a Type A deficiency, which must be corrected by the Plan of Correction by 12/1/23.

The facility representative Irma Paija acknowledges that upon receipt of a Type A deficiency, the Licensee shall post the LIC 809-D with the Type A deficiency for 30 days. Further, because a Type A deficiency was cited during this visit, the Licensee must provide a copy of this report to all parents, as well as newly enrolled parents, for the next 12 months. Additionally, form LIC 9224 (Acknowledgment of Receipt of Licensing Reports) must be signed by each existing parent and newly enrolled parent and a copy of that signed LIC 9224 form be placed in each child's file during the next 12 months.

LPA provided information guidance of the following web links that can be included on a staff training;

https://ccld.childcarevideos.org/child-care-center-operators/child-care-reporting-requirements/
https://ccld.childcarevideos.org/child-care-center-operators/supervising-children-in-child-care-centers/

An exit interview was conducted where the citation and plan of correction were discussed. Appeal rights were given and explained to the facility representative Irma Paija

A NOTICE OF SITE VISIT WAS PROVIDED. IT MUST BE POSTED NEAR THE FACILITY'S FRONT ENTRANCE AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2023
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 11/21/2023 09:57 AM - It Cannot Be Edited


Created By: Elimika Woods On 11/21/2023 at 08:51 AM
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: KIDANGO HILLSIDE
FACILITY NUMBER: 015700531

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/01/2023
Section Cited
CCR
101229(a)(1)

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101229( a)(1)-Responsibility for Providing Care & Supervision: No Child(ren) shall be left without the supervision of a teacher at any time. Supervision includes visual supervision
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The facility representative will create a written statement detailing new protocols in place to follow in order to prevent a child in care from being left unaccounted and without supervision. The Staff will watch the "Supervising Children in Child Care Centers" on the CCLD website. The facility representative will have all the staff sign and date the written statement
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This requirement was not met as evidenced based on interview. One child at the center was left outside unattended & without supervision for about five minutes which poses an immediate risk to the health, safety, or personal rights to persons in care.
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acknowledging that they have watched the assigned training video and understand their responsibility to provide supervision to children at all times and will implement the new protocols put in place. The facility representative will email this signed statement to LPA Woods know later than 12/01/23.

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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:Chandra Charles
LICENSING EVALUATOR NAME:Elimika Woods
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023


LIC809 (FAS) - (06/04)
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