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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408920
Report Date: 03/17/2023
Date Signed: 03/17/2023 10:13:14 AM

Document Has Been Signed on 03/17/2023 10:13 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:DISCOVERYLAND PRESCHOOLFACILITY NUMBER:
073408920
ADMINISTRATOR:WILLIS, JOCELYNFACILITY TYPE:
850
ADDRESS:800 GRAYSON ROADTELEPHONE:
(925) 935-3520
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 70TOTAL ENROLLED CHILDREN: 25CENSUS: 18DATE:
03/17/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Carmeliza EncarnacionTIME COMPLETED:
10:30 AM
NARRATIVE
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On 3/17/23 at 8:00 am Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced ANNUAL CONTINUATION inspection at Discoveryland Preschool. LPA observed all preschool children were at the Church Chapel for Friday prayers. LPA had to wait, and at 8:20 am met with Lead Teacher, Carmeliza Encarnacion and explained the purpose for today's inspection. Licensee/Director, Nichelle James-St.Helen is not present in the facility today and will be out for 3 weeks.

On 3/13/23 during a Required Annual Inspection LPA reviewed records and determined that 3 staff - JIN LUCAS, LORI RANNEY, CARMELIZA ENCARNACION were not associated to the license. Nichelle stated Jin was a new hire and started working in February 2023. Lori and Carmeliza worked in the center under old ownership and continued when ownership changed in 2022. Nichelle stated transfer requests were not completed, she did not verify their associations and was unaware of the Guardian fingerprint system. That day LPA Mathur was unable to complete the inspection process due to technical issues with laptop FAS system. Nichelle stated she would be out of facility for 3 weeks. She was informed a continuation inspection would be conducted in her absence and deficiency cited for JIN LUCAS. Nichelle followed up with LPA, provided transfer request forms all 3 staff were transferred and associated by CCLD office on 3/14/23.

Today 3/17/23 LPA returned to issue a deficiency Type A with $500 civil penalty for JIN LUCAS ($100 per day for maximum 5 days) since this staff was a new hire working for more than 5 days without association. Citation will also be cleared today as she is now associated and Letter of Clearance will be provided.

continued on page 809C
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2023
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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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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: DISCOVERYLAND PRESCHOOL
FACILITY NUMBER: 073408920
VISIT DATE: 03/17/2023
NARRATIVE
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LPA Mathur informed Teacher, Carmeliza that this report dated 3/17/23 with 1 Type A citation shall be posted for 30 consecutive days as there was immediate risk to the health, safety, or personal rights of children in care. Also, LPA Mathur informed Carmeliza to provide a copy of this licensing report dated 3/17/23 that documents any Type A citation(s) 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.

There were 18 children with 3 fully qualified staff present today.

Staff interview was not conducted.

Deficiencies are cited on pages 809D. This report was reviewed with Lead Teacher, Carmeliza Encarnacion. A NOTICE OF SITE VISIT WAS ISSUED, REQUIRED TO BE POSTED IN PUBLIC VIEW FOR 30 CONSECUTIVE DAYS.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 03/17/2023 10:13 AM - It Cannot Be Edited


Created By: Monica Mathur On 03/17/2023 at 09:12 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: DISCOVERYLAND PRESCHOOL
FACILITY NUMBER: 073408920

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)(2)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited. Newly hired staff JIN LUCAS has been working since Feb 2023 providing care for children was not associated to the license. Two staff LORI RANNEY and CARMELIZA ENCARNACION worked under previous ownership but their clearances were not transferred to the new license. Type A is cited with $500 civil penalty for Jin Lucas ($100/day for 5 days) as this poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/17/2023
Plan of Correction
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All 3 staff were associated by CCLD on 3/14/23. Defeciency was cleared today and Letter of Clearance provided. Licensee shall ensure moving forward all staff are cleared, associated and verified prior to initial presence at facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2023


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 03/17/2023 10:13 AM - It Cannot Be Edited


Created By: Monica Mathur On 03/17/2023 at 09:12 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: DISCOVERYLAND PRESCHOOL
FACILITY NUMBER: 073408920

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. Licensee, Nichelle stated she is unaware of the mandatory requirement and facility has not conducted water test for lead exposure. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/17/2023
Plan of Correction
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By POC Due Date 4/17/23 Licensee shall conduct water testing for lead exposure and submit documentation per written directives. LPA provided PIN 21-21.1-CCP and relevant information.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2023


LIC809 (FAS) - (06/04)
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