010204515-8-26-2021-52-CC-MOTI-C69SLS-20210826135849

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010204515
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:58:55 PM

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:	KIMBER HILLS PRESCHOOL		FACILITY NUMBER:	010204515
ADMINISTRATOR:	EITZEN, MEGAN		FACILITY TYPE:	850
ADDRESS:	39700 MISSION BOULEVARD		TELEPHONE:	(510) 651-5437
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY:	171	CENSUS: 34	DATE:	08/26/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Megan Eitzen		TIME COMPLETED:	02:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	(1) Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced on 8/26/2021 to conduct a Required - 1 Year inspection. LPA met with Director Megan Eitzen. Present during today's visit are 7 staff members and 34 preschool aged children. The center currently operates from 7:00AM to 6:00PM Monday through Friday. LPA toured the facility and play yard for a health and safety inspection. A review of staff records on 8/26/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. (6) Personnel files were reviewed. The teacher/child ratio was being met. (10) Children's files were reviewed. The classrooms and play yard are age appropriate and in good repair. Bathrooms are clean and in working order. The staff have a separate bathroom located within the facility. The sign in and out logs (facility is currently utilizing Brightwheel Software) were reviewed and accurate. Outdoor play area was free of hazards and provided a shaded area for the children and access to drinking water. There is a working telephone. Working carbon monoxide detector, smoke detector and fully charged fire extinguisher were observed at the facility. Opening and closing staff have current CPR and first aid training. LPA observed there are tight fitting lids on trash cans located inside the center. The center documents and conducts fire/disaster drills with the last one documented in March 2021. Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. See 809-C for second page of report....

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: KIMBER HILLS PRESCHOOL	FACILITY NUMBER: 010204515
	VISIT DATE: 08/26/2021

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Director is reminded that unusual Incidents must be reported within 24 hours by phone. Written report is to follow within 7 days utilizing form LIC624. LPA informed the Director that all forms can be downloaded at www.ccld.ca.gov and encouraged the Director to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Director was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

An exit interview was conducted with the Director, Megan Eitzen. No deficiencies are being cited on today's date. The Director was provided a copy of their appeal rights and the signature on this form acknowledges receipt of these rights. A Notice of Site visit was posted at the time of inspection and must remain posted for 30 days.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

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