013415659-12-19-2019-02-CC-PPEN-BJZSVZ-20191219131334

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013415659
Report Date: 12/19/2019
Date Signed: 12/19/2019 01:13:41 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	NIKASIA CHILD CARE CENTER		FACILITY NUMBER:	013415659
ADMINISTRATOR:	LEWIS, GWENDOLYN		FACILITY TYPE:	830
ADDRESS:	4143 MAC ARTHUR BOULEVARD		TELEPHONE:	(510) 531-9130
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	8	CENSUS: 6	DATE:	12/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Gwen Lewis		TIME COMPLETED:	01:30 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	Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced random annual site inspection for this infant care facility at 1140. LPA met and toured the facility for a health and safety inspection with the facility director, Gwen Lewis. Also present at this facility were six children in care and three additional staff. One of the staff is a qualified teacher, one is a teacher and one staff is an aid. The facility is within ratio and capacity. All adults present are background cleared and associated to this facility. This program is the infant component of a combination center and operates out of two rooms (the main infant care room and the crib room). There is also a preschool program located on site. Infant rooms/activity space is distinctly separate to preschool program rooms/spaces. There are two cribs present and the facility is licensed for two crib age children. Sleeping mats are available for older infant napping. Furnishings and equipment, including infant sleeping equipment, are age appropriate and free of broken/sharp pieces. The infant activity space is distinctly separate to the crib area. Surfaces including floors and counter tops are free of hazards and toxins. There were no hazardous items/toxins observed to be accessible to children in care today. There is one changing table which is in good repair. The facility has a working carbon monoxide detector, centralized smoke/fire alarm and fully charged fire extinguisher. Per facility staff the most recent fire department inspection was within the past year. Per facility staff there are no firearms present or stored on the premises. Formula and feedings brought from home are appropriately labeled. There is a working dishwasher present for bottle and utensil sanitation. Food preparation areas are kept clean and free of pests. Drinking water is available indoors and outdoors via individual sippy cups. Continued on Page 2*************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: NIKASIA CHILD CARE CENTER	FACILITY NUMBER: 013415659
	VISIT DATE: 12/19/2019

NARRATIVE

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This program has a fully fenced outdoor play space which is shared with the preschool. There is a waiver on file for the outdoor space and the space is used on a schedule to prevent commingling of infants/preschoolers. Play equipment is age appropriate and free of broken/sharp pieces. There is appropriate cushioning under and around play equipment. There are no pools, ponds or other accessible bodies of water present.

LPA reviewed the facility, personnel and children's records including children's admissions agreements, infant needs and services plans, and emergency information forms, staff teaching qualifications including infant course work and staff background clearances. A teacher qualification form was completed for one staff during this inspection. More than one staff present have current CPR/First Aid certification. All required postings are present including one waiver.

This facility provides Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information 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

Licensee is encouraged to visit www.ccld.ca.gov for licensing updates and forms. Contact: ChildCareAdvocatesprogram@dss.ca.gov to sign up for quarterly updates. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com. Infant Safe Sleep PIN Packet was provided and reviewed.

There were no deficiencies cited during this inspection. A notice of site visit was printed and posted and is to remain posted for 30 days. A copy of this report is to remain in the facility records and available for public review for a period of three years.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2