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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415293
Report Date: 02/23/2022
Date Signed: 02/23/2022 04:52:10 PM

Document Has Been Signed on 02/23/2022 04:52 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:AVONDALE EARLY EDUCATION CENTERFACILITY NUMBER:
274415293
ADMINISTRATOR:LUALEMANA, ROXANNEFACILITY TYPE:
850
ADDRESS:1405 LA SALLE AVENUETELEPHONE:
(831) 899-4757
CITY:SEASIDESTATE: CAZIP CODE:
93955
CAPACITY: 127TOTAL ENROLLED CHILDREN: 127CENSUS: DATE:
02/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Ghennay Woods & Sheriden CooleyTIME COMPLETED:
04:50 PM
NARRATIVE
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Licensing Program Analyst (LPA), Joe Macias, conducted an unannounced case management inspection in response to an unusual incident that the facility self reported to Community Care Licensing (CCL) on February 8, 2022. LPA met with the Director Ghennay Woods, and Assistant Director Sheriden Cooley and explained the nature of today's inspection. LPA toured the Facility both inside and outside during todays visit.

This inspection was made to inquire about an unusual incident that occurred on February 3, 2022.

During today's inspection LPA Macias toured the facility, interviewed staff, reviewed facility files, and obtained copies of pertinent information. Based on staff interviews, as well as the self reported incident report; a child's diaper was not changed during the duration of being present at the facility.

Prior to today's inspection the Director has reviewed diaper changing procedures with all staff. The facility held an all staff training to ensure the agency's policies are followed. Disciplinary action was taken against staff involved, and there is on going staff development. LPA Macias reviewed the diaper board procedures, and observed it in action.

As a result of this inspection a deficiency was cited.

Appeal right were printed and reviewed with the Director.

Type A cited, exit interview conducted, and a copy of this report was provided to the facility.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Joseph Macias
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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 02/23/2022 04:52 PM - It Cannot Be Edited


Created By: Joseph Macias On 02/23/2022 at 04:24 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: AVONDALE EARLY EDUCATION CENTER
FACILITY NUMBER: 274415293

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2022
Section Cited
CCR
101223(a)(2)

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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
A child's diaper was not changed during the duration of being present at the facility.
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Prior to today's inspection the Director has reviewed diaper changing procedures with all staff. The facility held an all staff training to ensure the agency's policies are followed.
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This requirement was not met and poses an immediate risk to the health, safety, and personal rights of children in care.
AB633 Parent Notification is required.
This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.
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Disciplinary action was taken against staff involved, and there is on going staff development. LPA Macias reviewed the diaper board procedures, and observed it in action. Deficiency cleared today.

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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:Joel Segura
LICENSING EVALUATOR NAME:Joseph Macias
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2022


LIC809 (FAS) - (06/04)
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