010214464-2-12-2024-52-CC-EWOS-D2DVX3-20240212154853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010214464
Report Date: 02/12/2024
Date Signed: 02/12/2024 03:49:00 PM

Document Has Been Signed on 02/12/2024 03:49 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	FUSD - CABRILLO STATE PRESCHOOL		FACILITY NUMBER:	010214464
ADMINISTRATOR:	BRENDA BETHANCOURT		FACILITY TYPE:	850
ADDRESS:	36700 SAN PEDRO DRIVE		TELEPHONE:	(510) 792-3015
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	24	CENSUS: 20	DATE:	02/12/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Donna Pitts & Brenda Bethancourt		TIME COMPLETED:	04:10 PM

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 February 12, 2024 at 1:15 PM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced 3 Year Required Inspection and met with the facility representatives, Donna Pitts and site supervisor, Brenda Bethancourt. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representatives. There were 20 preschool age children present during this inspection and three (3) additional staff members. The facility consists of one classroom located on the campus of Cabrillo Elementary School. The facility runs two separate 3 hour sessions, the AM session starts at 8:30 to 11:45 AM and the afternoon session starts at 12:10 PM to 3:30 PM. Monday-Friday. The facility was toured inside and out for a health and safety inspection. LPA checked the facility RECORDS and they show all individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. LPA conducted a census of the children and the census matches the children signed in on the electronic system. LPA reviewed three (3) children's files and two (2) staff files around 1:45 PM. All staff files have required Health Screening, and Employee Rights, and all children files contains Personal Rights, Medical Consent forms, and Identification & Emergency Information. 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 one classroom was inspected around 1:30 PM and teacher child ratio was observed. There are adequate play and learning materials available. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick is the library/quite area, away from other children in care. The center has a wired smoke detectors, a carbon monoxide detector, working telephone, first aid kits, and one fully charged 4A80BC fire extinguisher which meets standards established by the State Fire Marshal. Disaster drills are being conducted at least once every 6 months and the last one conducted was on 1/30/24. All required documents are posted in a public accessible area. See 809-C.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

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: FUSD - CABRILLO STATE PRESCHOOL	FACILITY NUMBER: 010214464
	VISIT DATE: 02/12/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

This facility provides healthy snacks for children in care. There are weekly menus posted at the facility. LPA observed an area where they have a refrigerator this area is clean and free of evidence of rodents. Food is protected from contamination and, per staff, contaminated food is discarded immediately. Pesticides and other similar toxic substances are not stored in cabinets that contains food. All storage containers for solid waste have tight fitting covers that are in good repair.

At 2:00 PM, LPA toured the outdoor play area. The outdoor area is fully fenced and free of hazards, it has two waivers in place that's shared with the kindergarten school. The areas around the slides and climbing areas have cushioning material underneath to absorb falls. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection. There are trees that provides shade to children while at play and the staff brings the children’s water bottles and cups to keep the children hydrated. The play equipment is age appropriate and in good repair.

The staff's bathroom is separate from the children's bathroom and all of the sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets and the paper towels and soap are available to the children.

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. The facility brepresentative was also reminded 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.

Lead Testing – Child Care Centers (CCC) CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP). ). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

See 809-C

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

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: FUSD - CABRILLO STATE PRESCHOOL	FACILITY NUMBER: 010214464
	VISIT DATE: 02/12/2024

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

The facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

The facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

There are no deficiencies cited today. 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 Donna Pitts.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC809 (FAS) - (06/04)

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