010206158-6-20-2019-02-CC-PPEN-BDBRWZ-20190620132359

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010206158
Report Date: 06/20/2019
Date Signed: 06/20/2019 01:24:27 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	BOOTH MEMORIAL DAY CARE		FACILITY NUMBER:	010206158
ADMINISTRATOR:	CRAWFORD, BRIDGETT		FACILITY TYPE:	850
ADDRESS:	2794 GARDEN STREET		TELEPHONE:	(510) 535-5088
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY:	60	CENSUS: 44	DATE:	06/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Bridgett Crawford/Huong Huynh		TIME COMPLETED:	01:30 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) Paul Petersen conducted an unannounced random annual site inspection for this facility at 0930. LPA met with site supervisor, Huong Huynh, and began a tour of all areas of the facility utilized by children in care for a health and safety inspection. Facility director, Bridgett Crawford arrived approximately 20 minutes after LPA's arrival and met with LPA to continue the facility tour. Also present at the time of this inspection were 44 preschool age children in care, including 15 toddlers, and 10 teaching staff, including three aides and seven teachers. The facility and each classroom is within ratio and capacity. Supervision is being provided for all children present. Per facility director, there are no firearms present or stored on the premises. Classrooms A, B, C, and D were inspected including furnishings and equipment for age appropriateness and absence of broken/sharp pieces. Toddler component classrooms are distinctly separate to the older children classroom and toddlers do not commingle with the older children. Counter tops and surfaces are free of toxins. Hazardous items are kept inaccessible to children in care via locked doors and child safety latches on drawers and cabinets. Children have individual storage cubbies for their personal belongings in all classrooms and drinking water is available in doors and out doors via individual sippy cups and water coolers. The facility has centralized smoke detectors/fire alarm system as well as working carbon monoxide detector. Multiple fully charged fire extinguishers are present. Per facility director, the most recent fire department inspection for this facility was within the past six months. There is heating and ventilation available for temperature management. Napping cots and linens are stored individually per child and per staff, linens are laundered at least weekly by facility staff. Breakfast, lunch and snacks are served by the facility with menus posted for public review. LPA inspected the food preparation and storage areas which is kept clean and appears free of pests. The outdoor play areas are fully fenced with a variety of age appropriate play equipment present. The high climbing equipment/slides has appropriate cushioning under and around the equipment and is securely anchored. There are no pools, hot tubs or other accessible bodies of water present. The separate grassy outdoor area is not currently utilized by children in care per director, and is scheduled to be restructured/repaired on July 19, 2019 via a large work project. Director will contact LPA to inspect the area after the work is completed prior to children using the area. LPA inspected the facility, personnel, and children's records including sign in, sign out sheets, staff background clearances, staff qualifications, staff immunization records, children's admissions agreements, children's immunization records, Continued on Page 2************************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

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: BOOTH MEMORIAL DAY CARE	FACILITY NUMBER: 010206158
	VISIT DATE: 06/20/2019

NARRATIVE

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and parent's rights forms. Multiple staff present are currently certified in CPR/First Aid. This facility provide Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. At approximately 1000, LPA observed a prescription medication present in a child, C1's, personal storage cubbie and not centrally stored. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information 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 For forms and updates visit www.ccld.ca.gov. Contact childcareadvocatesprogram@dss.ca.gov to sign up for quarterly updates.

The attached Type B deficiency was cited during this inspection. An exit interview was conducted with and a copy of the appeal rights was issued. A Notice of Site Visit was provided and the notice is to remain posted for 30 consecutive days. A copy of this report shall be maintained for 3 years and available for public review upon request.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: BOOTH MEMORIAL DAY CARE	FACILITY NUMBER: 010206158
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/20/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/05/2019 Section Cited CCR 101226(e)(1)	1 2 3 4 5 6 7	101226(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements. This facility was not in compliance with this requirement as evidenced by LPA's observation of a prescription medication,	1 2 3 4 5 6 7	The facility staff removed the medication from the child's cubbie to a central storage area which is inaccessible to children in care while LPA was present. In addition, the facility agrees to submit an acknowledgement regarding the need for children's prescription medications to be stored in a central location which is inaccessible to children in care
	8 9 10 11 12 13 14	epinephrine, present in the personal storage cubbie of child C1 posing a potential health and safety risk to the child.	8 9 10 11 12 13 14	with an unaltered label present for each medication. The facility will submit this by the POC date and the acknowledgment will be signed by all staff.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019

LIC809 (FAS) - (06/04)

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