013414055-8-22-2022-52-CC-EWOS-CHJUJG-20220822153730

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013414055
Report Date: 08/22/2022
Date Signed: 08/22/2022 03:37:45 PM

Document Has Been Signed on 08/22/2022 03:37 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:	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: 6	DATE:	08/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Lisa Perry		TIME COMPLETED:	04:00 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 August 22, 2022 at 1:45 PM., Licensing Program Analyst (LPA) Elimika Woods met with the facility representative, Lisa Perry to conduct an Unannounced 1 Year Required Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the representative. There was six (6) children present during this inspection and one (1) additional staff member. The facility is located on the campus of Palma Ceia Elementary School. The classroom and playground was toured for a health and safety inspection. Hours of operation are 8:15 AM to 11:15 AM for morning session, and 12:15 PM to 3:15 PM for afternoon session. CLASSROOMS: At 2:00 PM the facility was toured. There are adequate play and learning materials available and the floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation, and lighting at the center. There is proper individual storage space for each child. The isolation area for sick children is next to the director's desk. Drinking water is available inside and outside of the center. There's a fully charged 3A40BC fire extinguisher, a functioning carbon monoxide detector, and wired smoke detectors. All solid waste storage containers have tight fitting covers on, and appear to be in good repair. BATHROOMS AND TOILETING AREAS: There are separate bathrooms for staff and children. Toilets 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. FOOD SERVICE AREAS: There is no kitchen at this sited but lunch and breakfast is supplied by the school district. Low fat milk is being served at this facility. There are weekly menus posted at the facility and online. Pesticides and other similar toxic substances are not stored in cabinets that contains food. Food is protected from contamination and, per staff, contaminated food is discarded immediately. Food and beverages capable of rapid spoiling are properly stored. See 809-C.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022

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: HUSD CHILD DEVELOPMENT CTR. - PALMA CEIA	FACILITY NUMBER: 013414055
	VISIT DATE: 08/22/2022

NARRATIVE

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OUTDOOR PLAY AREAS: The playground area is fenced and all equipment and surfaces are safe and free from hazards. There's a large play structure which is anchored to the ground with cushioning to absorb falls. There are no bodies of water, or free standing water accessible to children. There are age appropriate toys and materials for the children and a canopy that provides shade to children while at play.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Three (3) children's file were reviewed around 2:30 PM. LPA reviewed the facility roster and obtained a copy. Staff files are maintained and stored in the Hayward School Districts Human Resource Office, 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. The facility representative's CPR and First Aid certificate is current and expires on 9/2023. The center is in compliance with the sign in and out procedure. Disaster drills are being conducted at least once every 6 months and the last one conducted was on 6/1/22. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: No IMS is being provided at this time and no medication is being stored at the 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.

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: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022

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: HUSD CHILD DEVELOPMENT CTR. - PALMA CEIA	FACILITY NUMBER: 013414055
	VISIT DATE: 08/22/2022

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

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.

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.

There are no deficiency cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Lisa Perry.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022

LIC809 (FAS) - (06/04)

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