013417824-12-19-2019-02-CC-PPEN-BJZSWL-20191219131431

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013417824
Report Date: 12/19/2019
Date Signed: 12/19/2019 01:14:38 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:	013417824
ADMINISTRATOR:	LEWIS, GWENDOLYN		FACILITY TYPE:	850
ADDRESS:	4143 MACARTHUR BLVD.		TELEPHONE:	(510) 531-9130
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94619
CAPACITY:	12	CENSUS: 11	DATE:	12/19/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Gwendolyn Lewis		TIME COMPLETED:	11:40 AM

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 facility at 0940. At arrival, LPA met with teacher, Asia Lewis, and began a tour of all areas of the facility which are licensed for child care. Also present at the time of LPA's arrival were 11 preschool age children in care and one additional teaching staff. All adults present are background cleared. One of the teaching staff is a qualified teacher and the other is an aide. The facility is within ratio and capacity. Facility director, Gwen Lewis, arrived while LPA was present and assisted with the remainder of the tour of the facility and review of the facility records. This program is the preschool component of a combination center with an infant program located on site also. The preschool program operates out of two classrooms (the main preschool room and the art room) with a children's storage cubby area also. The classrooms and storage cubby area as well as the preschool bathroom were inspected for health and safety. Furnishings, equipment and play items are age appropriate free of observed hazardous conditions. Surfaces, including floors and countertops, are free of toxins. Hazardous items/cleaning supplies are stored inaccessible to children in care. Children's napping equipment is available with napping linens/blankets stored separate for individual child use and sent home for laundering at least weekly. Per facility staff there are no firearms present or stored on the premises. This facility serves snacks. There is a snack menu posted. Children bring their own lunches from home. There is indoor and outdoor drinking water available for children in care via water pitchers and cups. There is a centralized smoke detector/fire alarm system, working carbon monoxide detector and fully charged fire extinguisher present. First aid supplies were inspected. Continued of 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: 013417824
	VISIT DATE: 12/19/2019

NARRATIVE

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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

The facility's outdoor play area is fully fenced and free of observed hazards. There is a waiver on file for outdoor play space use. The slide/climbing equipment present is age appropriate and securely anchored. There is cushioning around and under the climbing equipment. There are no pools or other bodies of water accessible to children.

LPA reviewed the facility, personnel and children's records including sign in/sign out records, children's admissions agreements, parents' rights forms, and emergency ID forms and staff teaching qualifications and background clearances. A teacher qualification form was completed for one staff during this inspection. All required postings are present including one waiver. At least one teaching staff present has current CPR/First Aid certification.

Facility Staff are encouraged to visit www.ccld.ca.gov for licensing updates and forms. Contact: ChildCareAdvocatesprogram@dss.ca.gov to sign up for quarterly updates. Staff are also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

There were no deficiencies cited during this inspection. A copy of the appeal rights was provided and a notice of site visit was printed and is to be posted for 30 days. A copy of this report is to remain in the facility records for a period of three years from today's date.

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