013412137-3-30-2023-52-CC-LDBX-CQER43-20230330124051

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013412137
Report Date: 03/30/2023
Date Signed: 03/30/2023 12:41:02 PM

Document Has Been Signed on 03/30/2023 12:41 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:	CAPE - HEAD START - HILL 'N DALE PRESCHOOL		FACILITY NUMBER:	013412137
ADMINISTRATOR:	NORMA CASTENADA		FACILITY TYPE:	850
ADDRESS:	4150 DORMAN ROAD		TELEPHONE:	(925) 426-8341
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94588
CAPACITY:	30	CENSUS: 12	DATE:	03/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Supriya Billa/Kristina Eplin		TIME COMPLETED:	01:00 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 March 30, 2023 at approximately 9:35AM., Licensing Program Analyst (LPA) Lorraine Dacanay Breaux arrived and conducted an unannounced Annual 1 year Required Inspection and met with facility representatives Supriya Billa and Kristina Eplin . LPA disclosed the purpose of the inspection and was granted entry. There were 12 children present during this inspection and five (5) additional staff members. The facility was toured for a health and safety inspection. The hours of operation are 8:00 AM-4:30 PM, Monday -Friday. CLASSROOMS: The facility is a one room classroom located on the campus of Donlon Elementary School. The classroom was inspected. 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, the facility uses a water jug container and disposal cups. There is proper individual storage space for each child. The isolation area for sick children is in the directors office away from other children in care. The center has a wired smoke detector, a carbon monoxide detector, working telephone, pull down fire alarm system, and a fully charged 3A40BC fire extinguisher. Per facility representative the facility is not currently administering medication. 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 are able to reach the sinks and toilets. Supplies are available to the children in care. FOOD SERVICE AREAS: This facility provides meals and snacks for the children. There is a monthly menus posted. LPA observed an area where they have a refrigerator this area is clean and free of evidence of rodents and litter. 1% milk is being provided. All storage containers for solid waste have tight fitting covers that are in good repair. See 809-C

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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

FACILITY NAME: CAPE - HEAD START - HILL 'N DALE PRESCHOOL	FACILITY NUMBER: 013412137
	VISIT DATE: 03/30/2023

NARRATIVE

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OUTDOOR PLAY AREAS: The school has a playground and garden area that the facility use for play. There's a play structure that is anchored with bark to absorb children's falls. There are large trees and a covered area that provides shade. Due to the current weather condition the inspection was limited.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Six (6) children's files and five (5) staff files were reviewed around 10:25 AM. All staff files have required Health Screening and Employee Rights. All children's files contained Identification & Emergency, Personal Rights, and Medical Consent forms. 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 center follows the sign in and out procedure. Disaster drills are being conducted at least once every 6 months at the last one conducted was on 02/09/2023. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: There's no IMS being provided at this time and no medication being stored at this facility. The center is equipped with a fully stocked first aid kit that is 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.

(No infant program at this facility.) 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.

See 809-C.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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: CAPE - HEAD START - HILL 'N DALE PRESCHOOL	FACILITY NUMBER: 013412137
	VISIT DATE: 03/30/2023

NARRATIVE

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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

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.

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.

There is a deficiency cited today (809-D). A notice of site visit was given and must remain posted for 30 days. Appeal Rights Provided. Exit interview conducted and report was reviewed with the facility representative, Kristina Eplin and Supriya Billa.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 03/30/2023 12:41 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: CAPE - HEAD START - HILL 'N DALE PRESCHOOL	FACILITY NUMBER: 013412137
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/30/2023

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 record review the child care center did not comply with the section cited above: Lead testing was not completed by Januaury 1, 2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/01/2023
	Plan of Correction
1 2 3 4	Have the lead testing completed and results emailed to LPA Dacanay Breaux at Lorraine.Dacanay-Breaux@dss.ca.gov

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: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

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