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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405698
Report Date: 09/28/2022
Date Signed: 09/28/2022 12:28:55 PM

Document Has Been Signed on 09/28/2022 12:28 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:FIRST BAPTIST HEAD START - EAST LELAND COURT CTRFACILITY NUMBER:
073405698
ADMINISTRATOR:ACOSTA, RAMONAFACILITY TYPE:
830
ADDRESS:2555 EAST LELAND ROADTELEPHONE:
(925) 473-2035
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 3DATE:
09/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Laquinda HillTIME COMPLETED:
12:30 PM
NARRATIVE
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On 9/28/22 10:15 AM Licensing Program Analyst (LPA) Michelle Sutton an unannounced Case Management inspection about an unusual incident self reported by the Center on 8/19/22. LPA met with Director Laquinda Hill and explained the purpose of today's inspection.

LPA interviewed staff and reviewed facility files. Copies of The Children's Roster, Personnel Report LIC500 and other relevant documents were obtained. During the inspection, it was determined that Child 1 was given a mango by the facility. In the child's file it was stated that child is allergic to mangos, has an Epipen and inhaler. At the time of the incident Epipen and inhaler were not stored at the facility.

Due to the issuance of Type A, this report has to be provided to all parents of currently and future enrolled over next 12 months. Report and deficiency page also to be posted in public view. A copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports to be signed by parent and kept in child file.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Laquinda Hill.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
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 09/28/2022 12:28 PM - It Cannot Be Edited


Created By: Michelle Sutton On 09/28/2022 at 11:54 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: FIRST BAPTIST HEAD START - EAST LELAND COURT CTR
FACILITY NUMBER: 073405698

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/29/2022
Section Cited
CCR
101226(b)

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101226 Health-Related Services (b) The licensee shall make prompt arrangements for obtaining medical treatment for any child if necessary.
This requirement is not met as evidenced by:
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By 9/29/22 Facility has agreed to get the require documents and medical treatments for Child 1. Director will submit a written statement understanding Licensing requirements and regulation.
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Based on observation, interviews and record reviews, the facility did not maintain Child 1 inhaler and epipen at the facility. This is an immediate risk to Health and Safety or Personal Rights risk to
persons in care.
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Type A
09/29/2022
Section Cited
CCR101227(a)(1)

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101227 Food Services (a) In child care centers providing meals to children, the following shall apply:(1)All food shall be safe and of the quality [..] needs of the children[..] This requirement is not met as evidenced by:
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By 9/29/22 Facility will conduct staff training on medical treatment for children with allergies and food services.
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Based on observation, interviews and record reviews, the facility did not maintain Child 1 was given a mango and it is documented in the child's file of being allergic. This is an immediate risk to Health and Safety or Personal Rights risk to
persons in care.
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Facility will submit proof to LPA of staff meeting.
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:Sherelle Johnson
LICENSING EVALUATOR NAME:Michelle Sutton
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022


LIC809 (FAS) - (06/04)
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