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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070213244
Report Date: 04/29/2022
Date Signed: 04/29/2022 12:06:22 PM

Document Has Been Signed on 04/29/2022 12:06 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:CALVARY CHRISTIAN SCHOOLFACILITY NUMBER:
070213244
ADMINISTRATOR:MULLENS, AMYFACILITY TYPE:
850
ADDRESS:3425 CONCORD BLVD.TELEPHONE:
(925) 682-6728
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY: 82TOTAL ENROLLED CHILDREN: 82CENSUS: 38DATE:
04/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Amy MullensTIME COMPLETED:
12:25 PM
NARRATIVE
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On 4/29/2022, Licensing Program Analysts (LPAs), Melissa Guirit and Nyeesha Blount conducted an unannounced complaint investigation that resulted in a case management. LPAs met with Director, Amy Mullens. During the course of the investigation, LPAs reviewed the unusual incident report that was reported to the regional office of the hand-foot-mouth disease. The Director reported four cases of the disease a month after it occurred. However, based on staff interviews, about 10-20 preschool and infant children contracted the disease with no report recorded in the system. Director was reminded that more than two children is considered an epidemic outbreak and that it must be reported to the office within 24 hours and that it must be reported to a local Health Department Officer.

See 809-D for two Type A deficiencies.

Exit interview conducted with Director, Amy Mullens. Copy of report and appeal rights provided. Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2022
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 04/29/2022 12:06 PM - It Cannot Be Edited


Created By: Melissa Guirit On 04/29/2022 at 11:11 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CALVARY CHRISTIAN SCHOOL
FACILITY NUMBER: 070213244

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/02/2022
Section Cited
CCR
101212(d)(1)(E)

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This requirement was not met as evidenced by document review and staff interviews. Unusual incident report was reported to the office a month after the hand-foot-mouth began. Per staff interviews, cases were reported to be between 10-20 cases. This poses a potential health and safety risk to children in care.
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Director, Amy will submit the follow-up written unusual incident report that indicates all the cases of hand-foot-mouth disease that ocurred in the facility. In addition, Director will watch the child care licensing video on reporting requirements and submit a statement to LPA on what it was about.
Type A
05/02/2022
Section Cited
CCR
101212(g)(1)

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This requirement was not met as evidenced by document review and staff interviews. Unusual incident reported indicated four children contracted the disease which already is beyond the number to report to the Health Department as an epidemic outbreak. This poses a potential health and safety risk to children in care.
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Director, Amy will watch the child care licensing video on reporting requirements and submit a statement to LPA on what it was about.

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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:Loretta Dyson
LICENSING EVALUATOR NAME:Melissa Guirit
LICENSING EVALUATOR SIGNATURE:
DATE: 04/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/29/2022


LIC809 (FAS) - (06/04)
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