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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417856
Report Date: 08/31/2021
Date Signed: 08/31/2021 04:14:07 PM

COMPREHENSIVE INSPECTION
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:PEACE TERRACE ACADEMYFACILITY NUMBER:
013417856
ADMINISTRATOR:ROOHI QADIRFACILITY TYPE:
850
ADDRESS:33330 PEACE TERRACETELEPHONE:
(510) 477-9946
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:29CENSUS: 21DATE:
08/31/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:22 AM
MET WITH:Roohi QadirTIME COMPLETED:
03:50 PM
NARRATIVE
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On 8/31/2021 at 10:22am Licensing Program Analyst (LPA) Morgan Pringle met with Director Roohi Qadir for an Unannounced Annual Inspection. Three (3) classrooms were toured for a health and safety inspection. Twenty-one (21) preschool children and five (5) staff were present during the inspection. The facility operates from 8:00am – 3:00pm.

The facility has age appropriate materials in all classrooms that are observed to be clean and in good condition. The outdoor space has ample shade for the children and has proper materials for the children. All toxins, cleaning products, medications, and hazardous materials were observed to be in inaccessible areas. All sinks and toilets were observed to be clean and in proper working order. The food preparation areas were observed to be clean and free from hazards. All knives and cleaning products in the food prep areas were made inaccessible to children in care. LPA did not observe any harmful or unattended bodies of water in or around the facility.

The facility is operating within its licensed capacity and is in ratio. All proper postings including the menu were made visible to parents and visitors in the entry way of the facility. The fire and disaster drill log has not been completed yet, Director states that the school has only been open for four (4) days since the summer. A physical census of the children and staff was taken and cross referenced with the sign-in and out log.

LPA obtained a sample of the children’s files and the staff files. Teacher and children’s files were incomplete.

Continued on 809-C

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
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: PEACE TERRACE ACADEMY
FACILITY NUMBER: 013417856
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/30/2021
Section Cited

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101170(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption...
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This requirement was not met as evidenced by: Based on record review Staff 03 does not have a full clearance. This poses an immediate risk to the health and safety of chldren in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
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: PEACE TERRACE ACADEMY
FACILITY NUMBER: 013417856
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2021
Section Cited

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101217 (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement was not met as evidenced by:
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Through file review all staff files are incomplete. This poses a potential risk to the health and safety of children in care.
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Type B
09/30/2021
Section Cited

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101221 (a) A separate, complete and current record for each child is maintained in the child care center. This requirement was not met as evidenced by: Through file review two children's files were incomplete. This poses a potential risk to the health and safety of children in care.
Type B
09/15/2021
Section Cited

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1596.8226(4)(b) (1)...a person who... is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training...This requirement was not met as evidenced by: File review showed all staff do not have Mandated Reporter training.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: PEACE TERRACE ACADEMY
FACILITY NUMBER: 013417856
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2021
Section Cited

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101216 (f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

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This requirement was not met as evidenced by: Through file review none of the staff have proper CPR & First Aid training. This poses a potential risk to the health and safety of children in care.
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Type B
09/30/2021
Section Cited

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(a) (1)...a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination...
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This requirement was not met as evidenced by: All staff missing immunizations. This poses a potential risk to the health and safety to the children in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: PEACE TERRACE ACADEMY
FACILITY NUMBER: 013417856
VISIT DATE: 08/31/2021
NARRATIVE
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The following Deficiencies were observed during today’s inspection

· Staff 03 did not have a fingerprint clearance or transfer


· Required Staff missing Pediatric CPR & First Aid Certification
· All staff files are incomplete
· All staff missing immunizations (MMr, Tdap, Influenza)
· All staff missing Mandated Reporter Training
· Child 04 and Child 10 files are incomplete

Director was reminded that ALL staff that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3,000 per person, per incident. Director was reminded of the responsibility as a mandated reporter.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. Facility is following IMS plan on file. When any changes to the IMS plan is made, an updated Plan for Providing 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.

All fire/disaster drills must be conducted every six (6) months and documented. The Director was reminded that any structural changes to the facility or additions to the childcare facility must be reported to Community Care Licensing.

Director was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

This report was read and given to the Director for a signature. There are six (6) deficiencies being cited today. This report shall remain on file for three (3) years. Appeal Rights were provided and exit interview conducted. A Notice of Site visit was given and must be posted for 30 days.

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan PringleTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5