010216208-4-13-2023-02-CC-DCAS-CQUQ5F-20230413115153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010216208
Report Date: 04/13/2023
Date Signed: 04/13/2023 11:52:09 AM

Document Has Been Signed on 04/13/2023 11:52 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ILE OMODE SCHOOL		FACILITY NUMBER:	010216208
ADMINISTRATOR:	KELLY KOUYATE		FACILITY TYPE:	850
ADDRESS:	8924 HOLLY STREET		TELEPHONE:	(510) 632-8230
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94621
CAPACITY:	23	CENSUS: 13	DATE:	04/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kelly Kouyate		TIME COMPLETED:	12:00 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 04/13/2023 at 9:00AM Licensing Program Analyst (LPA) Diana Campos conducted an unannounced Annual Required Inspection at Ile Omode School. LPA met with Director Kelly Kouyate and explained the purpose of today's inspection. LPA was granted inspection authority to enter the facility. The facility was toured to conduct a Health and Safety Inspection. Facility's operating days and hours are Monday-Friday 7:30AM-5:30PM. 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. The physical plant was inspected. LPA toured the premises with the Director. Indoor space: Facility operates in one classroom - Mama Jasiri : 2 teachers with 13 children. Facility was observed to be in compliance with teacher to children ratio requirement during LPA’s inspection. The classroom, restrooms, food storage areas and spaces accessible to children were inspected. Disinfectants, cleaning solutions, poisons and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Storage areas for poisons were locked and kept in a safe place inaccessible to children. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed, all toilets, hand washing areas are safe and in operating condition.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ILE OMODE SCHOOL	FACILITY NUMBER: 010216208
	VISIT DATE: 04/13/2023

NARRATIVE

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All floors were clean and safe. Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and free of rodents and other vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair. LPA observed Fire extinguisher, Smoke and Carbon Monoxide Detectors. All materials and surfaces accessible to children appeared to be toxic free.

Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards. Surface of the outdoor activity space was in safe condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were no bodies of water observed. Drinking water is readily available to children during indoor and outdoor activities via water dispenser and children's personal water bottles.

File Review: Children sign in and out procedures and logs were reviewed. All children were signed in by their authorized representative with full legal signatures. A sample of five (5) Children's files and Staff files was taken for review. A copy of the children's roster was reviewed and a copy obtained.

Center is not currently providing IMS services to children in care.
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

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Kelly Kouyate.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/13/2023 11:52 AM - 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ILE OMODE SCHOOL	FACILITY NUMBER: 010216208
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/27/2023
	Plan of Correction
1 2 3 4	Director will submit proof of documentaton following initial water sampling by POC date and copy of full report once that is completed.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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