013414055-8-29-2019-52-CC-LDYN-BFHSFA-20190829135001

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013414055
Report Date: 08/29/2019
Date Signed: 08/29/2019 01:50:06 PM

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 DEVELOPMENT CTR. - PALMA CEIA		FACILITY NUMBER:	013414055
ADMINISTRATOR:	HAZATONE, JOHN		FACILITY TYPE:	850
ADDRESS:	27679 MELBOURNE AVENUE		TELEPHONE:	(510) 293-9822
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY:	24	CENSUS: 20	DATE:	08/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Tiffany Hopper		TIME COMPLETED:	02:05 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 8/29/19 at 12:15pm, Licensing Program Analyst (LPA) Loretta Dyson arrived at the center for an unannounced random inspection. LPA met with Site Supervisor, Tiffany Hopper. There was 1 additional fingerprint cleared staff member and 20 children also present. The center operates in two half day sessions 8:15-11:15am and 12:15-3:15pm, Monday thru Friday. The center is located in a mobile unit on the campus of Palma Ceia Elementary School. LPA toured the playground and classroom to conduct a health and safety inspection. The classroom floors, surfaces and equipment are safe, clean and toxic free. There is a sufficient supply of age appropriate storage, toys, activities and furniture which are in good condition, and available for children in care. LPA did not observe any bodies of water, hazardous items or toxins accessible today. The classroom lighting, heating and ventilation is sufficient for the safety and comfort of children and staff. There is drinking water that is accessible for children both indoors and outdoors. All of the garbages used for solid waste have tight fitting covers that are in good repair. The toilets and sinks are in sanitary and operational condition. A separate bathroom is available for staff. The playground is fenced and the surfaces and equipment are in good condition. LPA did not observe any hazardous conditions today. The playground structure is anchored and has sufficient cushioning underneath to absorb a fall. There is shade on the playground. Food is prepared and brought to the center ready to serve. The center serves 1% milk to children. The center is in compliance with the sign in and out procedure. All required forms are posted and visible for public review, including the menu which is dated at least a week in advance. The center conducts fire and earthquake drills at least once every six months, with the elementary school, and the log indicates that the last drills were conducted on 6/4/19. The center has a fully charged 3A40BC fire extinguisher, working carbon monoxide detector, pull down fire alarm and wired smoke detectors installed, working telephone and first aid supplies. LPA reviewed the files of 4 children. LPA obtained a copy of the current facility and staff rosters. Staff files are maintained and stored in the Hayward Unified School District (HUSD) Human Resources Office, continued on 809C

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

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 DEVELOPMENT CTR. - PALMA CEIA	FACILITY NUMBER: 013414055
	VISIT DATE: 08/29/2019

NARRATIVE

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per the agreement with Licensing, and all licensing requirements for personnel are met as a condition of employment with the school district. At least one opening/closing staff member has a current CPR/First Aid certificate. Staff are reminded of their responsibility as mandated reporters.

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. 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. HUSD has already submitted an updated Plan of Operation that includes an IMS plan to Licensing. Ms. Hopper stated that there are no children currently enrolled that require medication.

There are no deficiencies being cited today. This report shall remain on file for 3 years. A notice of site visit was given and Ms. Hopper was reminded that it must remain posted for 30 days. An exit interview was conducted with Ms. Hopper.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

LIC809 (FAS) - (06/04)

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