010216194-7-6-2023-52-CC-RHAR-CTGSMM-20230706140010

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010216194
Report Date: 07/06/2023
Date Signed: 07/06/2023 02:00:19 PM

Document Has Been Signed on 07/06/2023 02:00 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:	DAVIS STREET CHILD CARE AT GARFIELD SCHOOL		FACILITY NUMBER:	010216194
ADMINISTRATOR:	PATTEN, MARY		FACILITY TYPE:	840
ADDRESS:	13050 AURORA DRIVE		TELEPHONE:	(510) 567-0322
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94577
CAPACITY:	40	CENSUS: 0	DATE:	07/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Jennifer Ralph		TIME COMPLETED:	02:15 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 July 6, 2023 at approximately 10:25am, License Program Analyst (LPA) Russ Haderer arrived unannounced for to conduct an inspection for health and safety. LPA met with the site supervisor, Jennifer Ralph. Present today is the site director, 2 staff and 1 child in care. The hours of operation are Monday to Friday 7AM to 5:30PM. The facility is located in a portable building located on the site of Garfield Elementary School. The portable building has two separate classrooms; one for the preschool license 013419489 and the other room for the school age children with indoor bathrooms in between. The school age classroom has a small kitchenette with two sinks with a microwave and toaster oven; and a staff office. There is a dedicated school age bathroom with a single toilet and a closing door for privacy, and sinks in the classroom for washing hands. There are cubbies available for all children's personal possessions. All hazardous materials and toxins are inaccessible to children in care. There are waste cans with covered lids for solid waste. The outdoor play area is shared with the preschool. A waiver is in place to ensure a schedule is maintained to prevent the children from co-mingling age groups and children are supervised by facility teaching staff to ensure this. All play equipment is in safe condition and free from sharp, loose, or pointed parts and the areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. There are no bodies of water accessible to children in care. All required posted documents were present. Disaster/fire drills are conducted at least monthly, the last drill was completed on 5/16/2023. All toilets, handwashing and cleaning areas are in safe and sanitary operating condition. Hot water is not available, there is a waiver allowing dishes to be washed in the main school cafeteria. All surfaces accessible to children are clean and toxic free. The sign in/out sheets are maintained on paper were reviewed and complete. The snack menu is posted and visible for review. Some food/snacks were expired – see LIC809D for deficiency.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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 4

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: DAVIS STREET CHILD CARE AT GARFIELD SCHOOL	FACILITY NUMBER: 010216194
	VISIT DATE: 07/06/2023

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

Lead testing for consumable water is complete and no exceedances were found. Results are publicly posted.

The facility is open in the afternoon for afterschool programs. The facility is clean and well organized with age-appropriate furnishings and equipment in good repair. Surfaces including floors and counter tops are free of hazards and toxins. There are sinks and a water fountain for the children. There are solid waste trash cans in both rooms with tight fitting lids and cubbies for children to store their belongings. There is a first aid kits hanging in backpacks on the wall near the exit door. The facility has a fully charged 3A40BC fire extinguisher last serviced on November 10, 2022. Smoke alarms and carbon monoxide detectors are present, tested and working.

Children’s records were reviewed. A facility roster was requested, and a copy made for the LPA. One child’s file was missing the form LIC627 Consent for Emergency Medical Treatment – see LIC809D for deficiency. All other records were complete and well organized. No children currently enrolled require any IMS service.

Staff records were reviewed. A personnel roster was requested, and a copy made for the LPA. All files selected were complete and well organized.

Site 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: DAVIS STREET CHILD CARE AT GARFIELD SCHOOL	FACILITY NUMBER: 010216194
	VISIT DATE: 07/06/2023

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

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/inspection-process.

There were two deficiencies issued today:

- Snack food was expired

- A child’s file was missing the Consent for Emergency Medical Treatment

See LIC809D for deficiencies cited today. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Jennifer Ralph.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 07/06/2023 02:00 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: DAVIS STREET CHILD CARE AT GARFIELD SCHOOL	FACILITY NUMBER: 010216194
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101221(b)(8)(C)

Child's Records

(b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status as specified in Section 101220, and the following health information: (C) A signed consent form for emergency medical treatment unless the child's authorized representative has signed the statement specified in Section 101220(f). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that one child's file was missing the LIC627 Consent for Emergency Medical Treatment form which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/12/2023
	Plan of Correction
1 2 3 4	Licensee to have parent complete and sign the LIC627 Consent for Emergency Medical Treatment form.

Type B

Section Cited

CCR

101227(a)(1)

Food Service

(a) In child care centers providing meals to children, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified by Title 7, Code of Federal Regulations, Part 226.20, (Revised January 1, 1990) Requirements for Meals, for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that some snack foods were found to be expired which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/06/2023
	Plan of Correction
1 2 3 4	Licensee immediately removed the expired food and will monitor all snack food going forward to ensure nothing is expired.

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: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

Page: 4 of 4