010214551-9-4-2019-52-CC-MMEA-BFPTDM-20190904143834

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010214551
Report Date: 09/04/2019
Date Signed: 09/04/2019 02:38:42 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:	HUSD CHILD DEV. PROGRAM - SHEPHERD		FACILITY NUMBER:	010214551
ADMINISTRATOR:	MCEWEN, TERESA		FACILITY TYPE:	850
ADDRESS:	27211 TYRRELL		TELEPHONE:	(510) 783-1182
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	24	CENSUS:	DATE:	09/04/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Augustina Noble		TIME COMPLETED:	02:45 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	A Case Management Visit was conducted on this date 9/4/19 by Licensing Program Analysts (LPAs), Mayla Mendoza and Loretta Dyson. LPAs met with center director, Augustina Noble. This center is a Title V program located on the premises of the Student Information Assessment Center. The center has submitted an application for an increase in capacity from 24 to 48 children. Room 1 is being added to the center license. The center will now be operating in 2 classrooms (Rooms 1 & 4). Hours of operation are from 8:15am-3:15am, Monday through Friday. A children's roster was obtained. Proper teacher-child ratio was observed during this visit. A health and safety inspection was conducted inside and outside. The following is the total overall measurement: INDOORS: 1802.033 square feet = 51 children OUTDOORS: 13061.79 square feet = 174 children Openers and closers have current CPR/FA. Playground equipment is in good condition. Drinking water is available inside and outside by way of water fountains. A yard waiver is being requested to allow for outdoor play to be shared with the Migrant Ed Preschool. Director is reminded that there shall be no commingling between the programs. A waiver is in place for use of the onsite cafeteria for preschool meals. This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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)/ (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.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: HUSD CHILD DEV. PROGRAM - SHEPHERD	FACILITY NUMBER: 010214551
	VISIT DATE: 09/04/2019

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
26
27
28
29
30
31
32

All toilets and handwashing facilities are in safe and sanitary operating conditions. Menus are posted. Meals are delivered from Helen Turner, pre-packaged. Breakfast, lunch and snacks are available in the center. There is adequate variety and quantity of foods to meet the children's needs. No napping equipment was observed, as the center is a half day program. The sign in and out logs were reviewed. Facility has a functioning carbon monoxide detector.

The center has obtained an approved fire safety inspection from the Hayward Fire Department on 8/20/19. All licensing required documents are posted.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

Zero Tolerance policies were explained. Notice of Site Visit form was provided and posted.
The center was found to be clean, safe, sanitary and in good repair. There are no deficiencies cited during this visit.

A license for 48 preschool children will be issued effective today 9/4/19.

An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2