010211857-8-15-2022-52-CC-LDBX-CHBPE5-20220815111435

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010211857
Report Date: 08/15/2022
Date Signed: 08/15/2022 11:14:46 AM

Document Has Been Signed on 08/15/2022 11:14 AM - 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:	EXTENDED DAY CHILD CARE - WALNUT GROVE		FACILITY NUMBER:	010211857
ADMINISTRATOR:	NATALIE GLYNN		FACILITY TYPE:	840
ADDRESS:	5199 BLACK AVENUE		TELEPHONE:	(925) 846-5519
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94566
CAPACITY:	120	CENSUS: 0	DATE:	08/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Natalie Glynn		TIME COMPLETED:	11:25 AM

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	On August 15, 2022 Licensing Program Analysts (LPA) Lorraine Dacanay Breaux arrived at the facility for a 1 Year required unannounced inspection, and met with Director Natalie Glynn. There were 0 (zero) children in care (this is a before and after care facility children are currently in school) and 1 staff member/Director present during the inspection. The facility was toured for a health and safety inspection both inside and out. The hours of operation are Monday through Friday, 07:00 am to 06:00 PM. The program is utilizing two portables. Per Director the multi purpose/Room 401 has not been used since COVID. CLASSROOMS: The two classrooms were inspected. 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 away from the children in care. LPA observed carbon monoxide detector and smoke detector located in each classroom. The center is equipped with a working telephone, carbon monoxide detector, pull down fire alarms and two fully charged 4A80BC 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 staff's bathroom is separate from the children's bathroom. All sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets. Supplies are available to the children. FOOD SERVICE AREAS: The kitchen is clean, adequately equipped, and LPA did not observe any food stored with cleaning supplies. Monthly snack menus are posted and available. This facility only provides snacks. -----------------------------See LIC 809 C ---------------------------

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

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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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: 08/15/2022

NARRATIVE

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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 yard is shared with the elementary school. Facility utilizes Walnut Grove Elementary School's grassy area and shaded top area.

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.

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.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

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: EXTENDED DAY CHILD CARE - WALNUT GROVE	FACILITY NUMBER: 010211857
	VISIT DATE: 08/15/2022

NARRATIVE

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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 care under this license)

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.

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 Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

LIC809 (FAS) - (06/04)

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