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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700744
Report Date: 01/09/2024
Date Signed: 01/10/2024 08:23:05 AM

Document Has Been Signed on 01/10/2024 08:23 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:PRIMARY SCHOOL-BAY AREA, THEFACILITY NUMBER:
015700744
ADMINISTRATOR:PLETZ, ASHLEYFACILITY TYPE:
850
ADDRESS:750 FARGO AVENUETELEPHONE:
(773) 870-1607
CITY:SAN LEANDROSTATE: CAZIP CODE:
94579
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 38DATE:
01/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Operations Director Mia Lopez and Program Director Mary GastonTIME COMPLETED:
04:30 PM
NARRATIVE
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On Tuesday, January 9, 2024, at 1:30 pm, Licensing Program Analyst (LPA) Manel Estoesta conducted a Case Management - Incident Visit. LPA met with the Operations Director Mia Lopez and Program Director Mary Gaston and explained the nature of the visit. Present on this visit were 9 Staff and 38 Preschool Children. The facility operates from Monday to Friday 8am to 5:30 pm.

On Tuesday, December 12, 2023, at 4:53 pm, Mia left a voicemail to report an Unusual Incident to the Oakland Southeast Regional Child Care Office Main Line to the Officer on Duty. A completed LIC 624 received via fax on 12/14/2023 at 12:18 pm.

The Unusual Incident was about that the Program Director Mary was informed that C1 was left on the gated playground unsupervised during a transition from the outdoor play area to the classroom, on 12/12/23 at approximately 11:45 am.

LPA conducted staff interview, a health and safety inspection, record review and obtained copies of the
LIC 9040 and LIC 500.

Based on LPA Staff Interview, on 12/12/23 at approximately 11:45 am, there were 2 staff assisting a group of preschool children at the outdoor play area transitioning to enter to their classroom. Mary saw C1 playing near the sand box unsupervised from Mary's glass window of her office. Mary came out to where C1 was and Early Childhood Education ECE Manager Kameelah Davis followed. Kameelah stayed with C1, and Mary went to the classroom to informed about the incident and spoke with the Lead Teacher. Mary and the Lead Teacher went back to the playground and the Lead Teacher brought back C1 to the classroom.


The Licensee is in violation of Section 101229 (a)(1) that no child(ren) shall be left without the supervision, including visual supervision, of a teacher at any time, except as specified in sections 101216.2 (e)(1) and 101230 (c)(1).
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: PRIMARY SCHOOL-BAY AREA, THE
FACILITY NUMBER: 015700744
VISIT DATE: 01/09/2024
NARRATIVE
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As per the LIC 624 dated 12/14/2023, the Plan of Correction (POC) was that involved Staff was given disciplinary warning and was reminded of the supervision guidelines. Also, C1's authorized representatives were informed of the incident.

LPA Estoesta informed the Directors and that this report dated 1/9/2024 included a Type A Citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Estoesta informed the Director to provide a copy of this licensing report dated 1/9/2024 that document of any Type A citation 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.

Civil Penalty of $500 immediately and $100 per day per violation until corrected.



Exit interview conducted and report was reviewed with Operations Director Mia Lopez and Program Director Mary Gaston.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
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Document Has Been Signed on 01/10/2024 08:23 AM - It Cannot Be Edited


Created By: Manel Estoesta On 01/09/2024 at 03:18 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: PRIMARY SCHOOL-BAY AREA, THE
FACILITY NUMBER: 015700744

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/10/2024
Section Cited
CCR
101229(a)(1)

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The Licensee is in violation of Section 101229 (a)(1) that no child(ren) shall be left without the supervision, including visual supervision, of a teacher at any time, except as specified in sections 101216.2 (e)(1) and 101230 (c)(1).
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As per the LIC 624 dated 12/14/2023, Plan of Correction (POC), the involved Staff was given disciplinary warning and was reminded of the supervision guidelines. Also, C1's authorized representatives were informed of the incident.
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Based on LPA Estoesta Staff Interview that C1 was left on the gated playground unsupervised during a transition from the outdoor play area to the classroom, on 12/12/23 at approximately 11:45 am which is an immediate health and safety risk to children in care.
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LPA recommended that the Directors should conduct a Staff Meeting to remind supervision guidelines. LPA will endorse the facility to the Technical Support Program (TSP) which is the non-enforcement service of CCLD and will informed the assigned Resource and Referral Agency for this facility.

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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:Jason Jang
LICENSING EVALUATOR NAME:Manel Estoesta
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024


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