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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214126
Report Date: 07/20/2023
Date Signed: 07/20/2023 09:52:40 AM

Document Has Been Signed on 07/20/2023 09:52 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LARPD EXTENDED STUDENT SERVICE - RANCHOFACILITY NUMBER:
010214126
ADMINISTRATOR:DICKINSON, DANAFACILITY TYPE:
840
ADDRESS:401 JACK LONDON BLVD.TELEPHONE:
(925) 960-2467
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 0DATE:
07/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Nancy BlairTIME COMPLETED:
10:05 AM
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On July 20, 2023, Licensing Program Analyst (LPA) Simerjit Kaur conducted an announced Case Management Inspection. LPA Kaur met with Director Brenda Rios and Youth Services Administrative Nancy Blair. This facility was on inactive status effective 7/30/2022 and would like to be placed back on active status. LPA Kaur toured the facility with Brenda Rios and Nancy Blair. The facility is located on campus of Rancho Las Positas Elementary School. The campus also has Heritage Charter program: Right At School. The Director is aware the school program may not commingle with the Heritage school and elementary school. The facility operates from Monday through Friday 7:00 AM - 8:30 AM, and 1:30 PM - 6:00 PM. During school district breaks, the facility operates Monday through Friday 7:00 AM - 6:00 PM.

Facility is currently licensed for Rooms A and B. Room B has staff bathroom, children bathroom, and office. The isolation area is the office. LPA discussed the importance of keeping hazardous items out of the reach of children. Facility director has current CPR and First Aid certificate, which was completed on 2/10/2023 and Mandated Reporter Training completed on 1/28/2022. The facility has carbon monoxide detectors, charged 3A40BC fire extinguishers and smoke detector/alarm system monitored by Protection 1 Company and Rancho Las Positas Elementary School. LPA Kaur spoke with Nancy Blair in regards to hiring qualified staff to care for the children. Facility will utilize fenced grass area adjacent to classrooms and black top on the of the School campus. The staff will provide 100% supervision during outdoor play time.
Continue on 809C.
Jason Jang
Simerjit Kaur
DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LARPD EXTENDED STUDENT SERVICE - RANCHO
FACILITY NUMBER: 010214126
VISIT DATE: 07/20/2023
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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.

Director was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.



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 Center 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.

Reminder: California Law requires Child Care Centers 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.

Facility is placed on active status effective today 7/20/2023.


This report shall remain on file for 3 years. A Notice of Site Visit was provided and exit interview was conducted.
SUPERVISOR'S NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
LIC809 (FAS) - (06/04)
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