013412359-2-25-2022-52-CC-SDOO-CBZ2WQ-20220225164557

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013412359
Report Date: 02/25/2022
Date Signed: 02/25/2022 04:46:16 PM

Document Has Been Signed on 02/25/2022 04:46 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:	DAVIS STREET AT JEFFERSON		FACILITY NUMBER:	013412359
ADMINISTRATOR:	LANGHAM, SHEILA		FACILITY TYPE:	840
ADDRESS:	14300 BANCROFT AVENUE		TELEPHONE:	(510) 483-3674
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94578
CAPACITY:	45	CENSUS: 13	DATE:	02/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Sheila Langham		TIME COMPLETED:	04:55 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 02/25/2022 at approximately 11:40am, Licensing Program Analyst (LPA) Sabina Dodoo and Licensing Program Manager (LPM) Chandra Charles met with Director Sheila Langham for an UNANNOUNCED ANNUAL REQUIRED INSPECTION of the School Age component of this combination day care center. This facility is located behind Jefferson Elementary School. Present for the inspection were the Director and 1 teacher who is fingerprint cleared. The total children enrolled are 45 and the census was 13 children at the time of the inspection. The Child Care Center is within ratio. The Child Care Center was toured to conduct a Health and Safety Inspection. The center currently operates Monday through Friday from 7am to 5:30pm. PHYSICAL PLANT: The sign in and out sheet is located outside the school age classroom for parents to sign and teachers meet the children at the door. The school age classroom is Room 3 (which is a Title 22 Classroom). There are ample learning materials for children to utilize in the classroom. There are cubbies with the children’s names on them that includes the backpacks and personal belongings of each child. LPA observed the boy’s and the girl’s bathroom that were found to be in operable condition. LPA observed the bulletin board (parent’s rights, emergency disaster plan, earthquake drills and facility license). All hazardous materials and toxins are kept out of reach from children and are not accessible. The Child Care Center has one fully charged fire extinguisher 3A-10- 40 BC, a working smoke detector, a working carbon monoxide, a telephone and fully stocked first aid kits. The furniture around the classrooms and outdoor activity area are all child proof and adequate for children to use. The learning materials are organized, and toys are kept in safety bins and cabinets for easy access for the children. *Continued on LIC 809C*

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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: DAVIS STREET AT JEFFERSON	FACILITY NUMBER: 013412359
	VISIT DATE: 02/25/2022

NARRATIVE

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KITCHEN: LPA observed the kitchen area is inaccessible to day care children. The kitchen area is neat and clean with the current food menu posted. The food menu is posted throughout the facility. This facility provides breakfast, lunch, am and pm snacks. The school is serving low fat milk.

OUTDOOR: LPA Dodoo observed the outdoor play area which consist of a climbing play structure with a slide and two swings. The play structure is affixed to the ground and has a cushioned material all around to absorb falls. The play structure is maintained by the San Leandro Unified School District. The school age play yard is separated from the preschool play yard. There is a fence around the play area and locked gates. There are no bodies of water on the premises. There are no firearms on premises.

RECORDS: At 3:30pm LPA Dodoo reviewed 5 children’s files and 1 staff file and documented them on LIC 857 and LIC 859. An updated roster was viewed by LPA Dodoo. A copy was obtained from the Director. The staff interview was completed with Director Sheila Langham. The Director and staff have completed the Health and Safety training and CPR/First Aid is current. The Director and Staff are following the immunization laws and have completed the mandated reporter training. The Director has conducted and documented the fire and disaster drills twice a year and the last conducted drill was on February 25^th, 2022. All required forms are posted and visible for public view.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS (Incidental Medical Services) to children in care at this time. If any IMS is provided, a Plan for Providing 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: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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: DAVIS STREET AT JEFFERSON	FACILITY NUMBER: 013412359
	VISIT DATE: 02/25/2022

NARRATIVE

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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.

Director was reminded that all adults 18 and over working in Child Care Center, 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 licensed 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.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

Licensee was reminded of the responsibility as a mandated reporter and the trainings must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care 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 to the regional office by phone and the written report, LIC 624 within 7 business days.

There were no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Exit Interview and staff interview was conducted with Director (Sheila Langham).

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC809 (FAS) - (06/04)

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