010214551-3-24-2022-52-CC-EWOS-CCTR79-20220324124558

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010214551
Report Date: 03/24/2022
Date Signed: 03/24/2022 12:46:07 PM

Document Has Been Signed on 03/24/2022 12:46 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 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:	48	CENSUS: 17	DATE:	03/24/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Agustina Noble		TIME COMPLETED:	01:15 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 March 24, 2022 at 11:00 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced 1 Year Required Inspection and met with Site Supervisor, Agustina Noble. LPA disclosed the purpose of the inspection and was granted entry into the facility by the director. There were seventeen (17) children present during this inspection and three additional staff members. The center operates out of classrooms 1 & 4 on the campus of the Student Information and Assessment Center and operates in two sessions Monday - Friday, 8:15-11:15 AM and 12:15-3:15 PM. The facility playground and classrooms was toured for a health and safety inspection. CLASSROOMS: The two (2) classrooms were inspected. There are adequate play and learning materials available to children and the floors, furniture, and equipment are age appropriate and in good repair. There is proper individual storage space for each child. The ISOLATION AREA for sick is next to the director's desk, away from other children in care. There is adequate heating/air conditioning, ventilation and lighting. Drinking water is available inside and outside of the center. The center has a wired smoke detectors, a carbon monoxide detector, working telephone, pull down fire alarm system, and two (2) fully charged 3A40BC fire extinguishers. RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Three (3) children's files were reviewed around 11:25 AM. All files have required Personal Rights, Identification & Emergency, and Medical Consent forms. Staff files are maintained and stored in the Hayward Unified School District (HUSD) Human Resources Office, and all licensing requirements for personnel are met as a condition of employment with the school district. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. Staff are reminded of their responsibility as mandated reporters. The center is in compliance with the sign in and out procedure. Disaster drills are being conducted at least once every 6 months, in conjunction with the elementary school. 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: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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: HUSD CHILD DEV. PROGRAM - SHEPHERD	FACILITY NUMBER: 010214551
	VISIT DATE: 03/24/2022

NARRATIVE

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FOOD SERVICE AREAS: There are weekly menus posted at the facility. Lunch is provided by the center and it is brought to the facility already prepared. Low-fat milk is being served at the center. LPA observed an area where they have a mini refrigerator this area is clean and free of evidence of rodents. All storage containers for solid waste have tight fitting covers that are in good repair.

OUTDOOR PLAY AREAS: There's a play structure that has cushioning to absorb falls. There are canopies/awning that provides shade to children while at play. There's a water station table with cups to keep the children hydrated. There a several sheds with locks that stores equipment on the playground.

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.

HEALTH RELATED SERVICES: No IMS is being provided at this time and no medication is being stored at this facility. The center is equipped with fully stocked first aid kits that are available in the classroom.

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.

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

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: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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: HUSD CHILD DEV. PROGRAM - SHEPHERD	FACILITY NUMBER: 010214551
	VISIT DATE: 03/24/2022

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 facility representative 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.

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.

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.

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, Agustina Noble.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC809 (FAS) - (06/04)

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