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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211857
Report Date: 11/19/2021
Date Signed: 11/19/2021 12:00:56 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:EXTENDED DAY CHILD CARE - WALNUT GROVEFACILITY NUMBER:
010211857
ADMINISTRATOR:NATALIE GLYNNFACILITY TYPE:
840
ADDRESS:5199 BLACK AVENUETELEPHONE:
(925) 846-5519
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY:120CENSUS: 29DATE:
11/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Natalie GlynnTIME COMPLETED:
12:15 PM
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On November 19, 2021, Licensing Program Analysts (LPA) Lorraine Dacanay Breaux arrived at the facility for a 1 Year required unannounced inspection, and met with director Natalie Gynn. There were 29 children in care and 4 staff members present during the inspection. The facility was toured for a health and safety inspection. The hours of operation are Monday through Friday, 07:00 AM to 06:00 PM.

CLASSROOMS: The two classrooms were inspected (Cubs, Lions/Tigers). Teacher-child ratio was observed. There are adequate play and learning materials available. There is adequate heating/air conditioning, ventilation and lighting. The floors, furniture, and equipment are age appropriate and in good repair. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is in the directors office until parents pick up. LPA observed and tested the carbon monoxide detectors and smoke detectors located in each classroom. The center is equipped with a working telephone, carbon monoxide detector, pull down fire alarms and fully charged 3A40BC fire extinguishers and fully stocked first aide kits. All solid waste storage containers have tight fitting covers on, and appear to be in good repair.

BATHROOMS AND TOILETING AREAS: The bathrooms are separate for staff and children. Toilets and faucets are in safe and sanitary operating condition.

FOOD SERVICE AREAS: The kitchen is clean, adequately equipped, and LPA did not observe any food stored with cleaning supplies.Food was labeled. Monthly snack menus are posted and available. Parents bring the children's lunches.

OUTDOOR PLAY AREAS: There are no bodies of water, or free standing water accessible to children. There are age appropriate toys and materials for the children. The playground is fenced and all equipment and surfaces are free from hazards. The playground stops at the basketball courts. All shed have locks.
-----------------------------See LIC 809 C ---------------------------
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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: EXTENDED DAY CHILD CARE - WALNUT GROVE
FACILITY NUMBER: 010211857
VISIT DATE: 11/19/2021
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RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Children's files and staff files were reviewed. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. Mandated Reporter Training was discussed and certificates were reviewed. The center is in compliance with the sign in and out procedure. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: IMS is being provided at this facility. LPA inspected the medication, which is stored in a safe place that is inaccessible to children in care. Each of the medications has an unaltered label with the child’s name and date of issuance. The center is equipped with fully stocked first aid kits that are available in the classrooms and playgrounds.

California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented. Last drill was October 21, 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.



LPA discussed the safe sleep regulations with facility representative 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 Rajeswari Srihara 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. (No infants in care at this time.)
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: EXTENDED DAY CHILD CARE - WALNUT GROVE
FACILITY NUMBER: 010211857
VISIT DATE: 11/19/2021
NARRATIVE
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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 (8000 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 director was provided information regarding effects of Lead Exposure and testing requirements (Assembly Bill 2370).



A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility Director Natalie Glynn.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-BreauxTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
LIC809 (FAS) - (06/04)
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