010210783-10-26-2022-52-CC-JSAI-CKKR6S-20221026124512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010210783
Report Date: 10/26/2022
Date Signed: 10/26/2022 12:45:30 PM

Document Has Been Signed on 10/26/2022 12:45 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	RESURRECTION LUTHERAN PRESCHOOL		FACILITY NUMBER:	010210783
ADMINISTRATOR:	WAZHMA MASARWEH		FACILITY TYPE:	850
ADDRESS:	7557A AMADOR VALLEY BOULEVARD		TELEPHONE:	(925) 829-5487
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	80	CENSUS: 49	DATE:	10/26/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Assistant Director Erika Hidley		TIME COMPLETED:	01:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Jyoti Saini met with assistant director, Erika Hidley for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Staff. In addition to the director, there are 49 children and 11 staff members present today. The facility operates Monday - Friday from 7;30 AM to 5:30 PM in room #1( AKS Owls),room #4 (AKS,busy bees) room #5 (AKS Tigers) and room# 6 AKS( superstars). The facility was inspected indoor and outdoor today for health and safety hazards and the following was observed.

There are no bodies of water, firearms, or weapons on the premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. A first aid kit and a first aid backpacks are available. The outdoor play area is fenced for supervision. The play structure is age-appropriate and in good condition. There are separate bathrooms for the children and staff. The bathrooms appear to be safe, sanitary, and free of any hazardous items. There is drinking water readily available for children. Mats are available for use of children. The bedding is sent home weekly to be washed by the parents. Children bring their own lunch and the facility provides the snacks. The classroom has appropriate postings. The last Emergency Drill was conducted on 010/20/2022 at 9:40am and is properly logged.

LPA reviewed sign-in and out sheet. The center has a complete record of sign-in/out sheets by an authorized pick up person. There is a working fire alarm system in the facility. The Facility has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available.

All the Children records reviewed were complete. All children have a record of emergency identification information on file. All staff has a criminal record clearance on file. The staff has a current Pediatric First Aid/CPR certificate on file and have taken Mandated Reporter training. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site always or present during off-site activities (field trips). Facility roster was obtained.

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SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022

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 10/26/2022 12:45 PM - It Cannot Be Edited

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: RESURRECTION LUTHERAN PRESCHOOL	FACILITY NUMBER: 010210783
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(2)

Health-Related Services

(2) All prescription and nonprescription medications shall be maintained with the child's name and shall be dated. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation,record review the licensee did not comply with the section cited above.C8 and C9's epipens/medications were found to be expired, which poses a potential health, safety or personal rights risk to children in care.
	POC Due Date: 10/28/2022
	Plan of Correction
1 2 3 4	The director shall return the expired EpiPens/medications to the parents and obtain un-expired EpiPens/medications. All Incidental Medical Plans should be followed and medications checked on a regular basis to ensure that no medications become expired.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022

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: RESURRECTION LUTHERAN PRESCHOOL	FACILITY NUMBER: 010210783
	VISIT DATE: 10/26/2022

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During inspection,

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.

Site Director was reminded about Mandated Reporter Training available on the CCLD website. Training must be completed every two years. (Websites: www.ccld.ca.gov or www.mandatedreporterca.com)

Site Director was reminded about the Provider Information Notices (PINs) on the CCLD website.

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.

The following deficiency is (See LIC 809-D.) cited from the California Code of Regulations, Title 22

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

Exit interview conducted and report was reviewed with the facility representative, Erika Hidley

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022

LIC809 (FAS) - (06/04)

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