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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213003
Report Date: 06/01/2023
Date Signed: 06/01/2023 04:51:42 PM


Document Has Been Signed on 06/01/2023 04:51 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:ALAMEDA ISLAND KIDS AT EDISON SCHOOLFACILITY NUMBER:
010213003
ADMINISTRATOR:NAVARRO, CHRISTINEFACILITY TYPE:
840
ADDRESS:2700 BUENA VISTA AVE.TELEPHONE:
(510) 769-1975
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:98CENSUS: 33DATE:
06/01/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Angela SmithTIME COMPLETED:
05:10 PM
NARRATIVE
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On 6/1/23 at 12:45PM, Licensing Program Analyst (LPA) Catherine Fernandes met with Director Angela Smith for a case management annual continuation inspection. The center and playground were toured to conduct a Health and Safety inspection. There were 33 school age children in care along with four additional staff members. Operating hours are 7:00am to 8:30am and 11:30am to 6:00pm, Monday through Friday. The center follows the Alameda Unified School District calendar.

The center operates out of the Edison Elementary school and consists of one room(rm 1) and the auditorium. The room floors, surfaces, furniture and equipment appear to be safe, sanitary and in good repair. The heating, lighting and ventilation is adequate. There are toilets and sinks available for the children. There are supplies available for the children to wash and dry their hands. The bathrooms are sanitary and in operational conditions. There is a separate bathroom for staff. The activities and toys appear to be age appropriate for the children in care. The outside play area is fully fenced with a shaded areas and age appropriate toys. There are play structures with rubber material to absorb the impact from a fall. LPA did not observe any bodies of water, free standing water, cleaning supplies, or toxic items accessible to children during todays inspection. The center prepares and provides snacks to the children while in care. The children have their own hooks to store their belongings. All children have access to clean drinking water indoors and outdoors. The classroom has a fully charged fire extinguisher and the fire system is hardwired.

All postings are made visible in classroom 1. The fire/disaster drill log was complete with the last drill logged 5/9/2023. LPA reviewed the sign in and sign out sheets. LPA obtained the facilities files, six children’s records and all staff files were reviewed. LPA observed six out of six children's files were missing form LIC627. Mandate Reporter training has been completed and current.

Report continued on 809C

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
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 06/01/2023 04:51 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, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: ALAMEDA ISLAND KIDS AT EDISON SCHOOL
FACILITY NUMBER: 010213003

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/29/2023
Section Cited
CCR
101221(a)

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101221(a) Child's Records A separate, complete and current record for each child is maintained in the child care center.
This requirement has not been met as evidenced by:
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The center will provide LIC 627 to all enrolled children and audit all children's records to verify all files are complete. Then send a statement to CCL by POC date.
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Based on file reviews, 6 of the 6 children's files were missing form LIC627 which is a potential risk to children in care.
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Type B
06/29/2023
Section Cited
CCR101227(a)(6)

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101227 Food Service- Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. This requirement has not been met as evidenced by:
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Center will submit a wriiten menu to CCL by POC date.
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Based on observations the snack menu did not reflect what is being served which is a potential risk to the health and safety of the children in care.
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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: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4


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: ALAMEDA ISLAND KIDS AT EDISON SCHOOL
FACILITY NUMBER: 010213003
VISIT DATE: 06/01/2023
NARRATIVE
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Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities 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 email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com. 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. NO IMS IS BEING PROVIDED AT THIS TIME.

Director 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.

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 is needed for the facility file: SEE 809D FOR citations


LIC500 Personnel report
Director Packet
Copy of the children's roster
A notice of site visit was given and must remain posted for 30 days
Exit interview conducted and report was reviewed with the Director
Report and Appeal Rights provided.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/01/2023 04:51 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, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: ALAMEDA ISLAND KIDS AT EDISON SCHOOL
FACILITY NUMBER: 010213003

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/29/2023
Section Cited
HSC
1596.954

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Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. This requirement is not met as evidence by:
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Center will provide proof of a carbon monoxide detector by POC date.
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Based on observation and interview, the center does not have a carbon monoxide detector which poses a potential health risk to children in care.
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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: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4