010206146-4-28-2022-02-CC-DCAS-CDWW52-20220428165826

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010206146
Report Date: 04/28/2022
Date Signed: 04/28/2022 04:58:38 PM

Document Has Been Signed on 04/28/2022 04:58 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:	OUSD - MANZANITA		FACILITY NUMBER:	010206146
ADMINISTRATOR:	BIRDIE WINROW		FACILITY TYPE:	850
ADDRESS:	2618 GRANDE VISTA AVENUE		TELEPHONE:	(510) 879-0829
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	79	CENSUS: 30	DATE:	04/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Bolanle Adelaja		TIME COMPLETED:	05:10 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	Licensing Program Analyst (LPA) Diana Campos conducted an unannounced annual required inspection. This is a Title 5 facility. LPA met with Head Teacher Bolanle Adelaja, and toured all areas utilized by children in care for a health and safety inspection. Present during inspection were 7 staff and 30 preschool age children. The facility is within ratio and capacity. Per facility staff, there are no firearms stored on the premises. Meals and snacks are pre-packaged and delivered from an outside service. There are menus available for review. Counter tops and surfaces are free of toxins/hazardous items. There is centralized smoke/fire alarm inspected by city fire and a working combination carbon monoxide detector. There are multiple fully charged fire extinguishers. All required postings are present. Bathroom faucets and toilets are in working order. The facility has lighting and heating for safety and comfort. The outdoor play areas are fully fenced and separate to the school age children play area. LPA observed in one of the outdoor play areas protruding tree roots that can be a tripping hazard to the children in care. There are no pools or other accessible bodies of water and climbing equipment is securely anchored with cushioning under/around the equipment. Drinking water is available indoors and outdoors via individually labeled water bottles. There are individual/separate storage cubbies for children's belongings as well as sleeping cots and linens. A review of cleaning and food supply storage areas was made. First Aid supplies are available in each classroom. All staff subjected to criminal review have been cleared through OUSD as a term of their employment. Staff certification in CPR and First Aid is current and valid for opening and closing staff members at this site. A sample of children's files were reviewed and found to be complete. This facility provides Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: OUSD - MANZANITA	FACILITY NUMBER: 010206146
	VISIT DATE: 04/28/2022

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
26
27
28
29
30
31
32

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
To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

Site Administrator 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.

LPA discussed the safe sleep regulations with Site Administrator and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee Site Administrator of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA will return at a later date to conduct a review of staff files and complete inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Site Administrator Caroline Jones.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2