013417824-6-23-2023-02-CC-EWOS-CT3VGK-20230623162539

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013417824
Report Date: 06/23/2023
Date Signed: 06/23/2023 04:25:48 PM

Document Has Been Signed on 06/23/2023 04:25 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
BAY AREA-CC OAKLAND, 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: 7	DATE:	06/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Gwendolyn Lewis		TIME COMPLETED:	04:45 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 June 23, 2023 at 2:15 PM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced 1 Year Required Inspection and met with the facility representative, Gwendolyn Lewis. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representative. There were seven (7) children present during this inspection and three (3) additional staff members. The facility consists of one classroom. This center has an infant component on site license number #013415659. The facility was toured inside and out for a health and safety inspection. The hours of operation are 7:00 AM-6:00 PM, Monday -Friday LPA checked the facility RECORDS and they show all individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. LPA conducted a census of the children and the census matches the children signed in on the sign in sheet. LPA reviewed two (2) children's files and three (3) staff files around 3:00 PM. All staff files have required Health Screening, and Employee Rights, and all children files contains Personal Rights, Medical Consent forms, and Identification & Emergency Information. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. Mandated Reporter Training was discussed, and certificates were reviewed. Director's CPR and First Aid certificate is current and expires on 08/2023. The one classroom was inspected around 2:30 PM and teacher-child ratio was observed. There are adequate play and learning materials available. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is the director's office, away from other children in care. There is a centralized smoke detector/fire alarm system, working carbon monoxide detector and fully charged fire extinguisher present. Disaster drills are being conducted at least once every 6 months and the last one conducted was on 05/22/23. All required documents are posted in a public accessible area. See 809-C.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: NIKASIA CHILD CARE CENTER	FACILITY NUMBER: 013417824
	VISIT DATE: 06/23/2023

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

There's no IMS being provided at this time and no medication being stored at the facility. The center is equipped with a fully stocked first aid kit that is available in the classrooms.

This facility provides snacks for the children. There are weekly menus posted at the facility. All storage containers for solid waste have tight fitting covers that are in good repair. The children's bathroom is separate from the staff's bathroom and the sinks and faucets are in safe and sanitary operating condition. Paper towels and soap are available to the children at all times.

The outdoor area has a play structure with a slide that has cushioning to absorb falls. There's a canopy that provides shade to children while at play and the staff brings the children’s water bottles and cups to keep the children hydrated. The play equipment is age appropriate and in good repair. There's a shed with a lock that is inaccessible to children on the playground.

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) 622-2550
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: NIKASIA CHILD CARE CENTER	FACILITY NUMBER: 013417824
	VISIT DATE: 06/23/2023

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.

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 deficiencies 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, Gwendolyn Lewis.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023

LIC809 (FAS) - (06/04)

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