013420540-10-19-2022-02-CC-ASIH-CKCUS4-20221019154944

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420540
Report Date: 10/19/2022
Date Signed: 10/19/2022 03:50:24 PM

Document Has Been Signed on 10/19/2022 03:50 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:	ALAMEDA HEAD START - SUE MATHESON INFANT CENTER		FACILITY NUMBER:	013420540
ADMINISTRATOR:	TRUONG, VICKIE		FACILITY TYPE:	830
ADDRESS:	670 WEST MIDWAY		TELEPHONE:	(510) 521-3443
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94501
CAPACITY:	8	CENSUS: 0	DATE:	10/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Kym Akintomide		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 10/19/2022 Licensing Program Analyst (LPA), Arminder Singh conducted an unannounced annual/random inspection at facility. LPA met with Director, Kym Akintomide and explained the purpose of today’s inspection. Hours of operation are Monday- Friday 8:00AM-3:00PM. During today's visit there were no children present. The facility currently has 5 children enrolled. The facility has a professional staff development day today which is why there are no children present today. The Director is the only staff at the facility today. All staff are in training today. LPA toured the Facility during today's inspection. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), activity Schedule, and lunch menu. The infant program operates out of Room #1. Staff have current mandated reporter training and current CPR and First Aid certifications on file. Facility understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). Facility conducts fire/earthquake drills at least once every six months. Last one was conducted on 09/2022. Facility understands the conditions, limitations, and capacity specifications of the Facility license. Facility understands that children shall be visually supervised at all times. Continued on 809-C

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

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

FACILITY NAME: ALAMEDA HEAD START - SUE MATHESON INFANT CENTER	FACILITY NUMBER: 013420540
	VISIT DATE: 10/19/2022

NARRATIVE

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The Facility is aware of the required sign in and sign out procedures. Children are picked up by their respective parent(s)/guardian(s) and no child is allowed to go home on his/her own. Parents drop off/pick up children at the front of the classroom, where the children are signed in/signed out.

LPA observed that the classroom is clean and safe for all children and staff. Staff and children's bathrooms are clean, sanitary, and operable. Staff bathroom can be used as an isolation bathroom if needed. Facility does not have any weapons or firearms on the premises.

The Alameda Unified School District provides the children breakfast, lunch, and snacks. Emergency supply of snacks are readily available at facility. Cleaning supplies and poisons are made inaccessible to the children and stored in locked cabinets.

LPA observed all furniture and equipment is in good condition and safe for the children.

Outdoor Space: Facility has an outdoor playground that is separate from the preschool program play ground. The infant playground is fenced off from the other play ground to avoid commingling. Playground was inspected and observed to be safe . The play equipment was maintained in good condition and free of hazards. The play area has a padded surface. There were no bodies of water observed. Drinking water is arranged to be readily available to children via individual water bottles. Facility has a filtered water filling station. The play area has a shaded area as well.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

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

FACILITY NAME: ALAMEDA HEAD START - SUE MATHESON INFANT CENTER	FACILITY NUMBER: 013420540
	VISIT DATE: 10/19/2022

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Director 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.

LPA discussed the safe sleep regulations with Director 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 Director 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.

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.

In today's visit there were no deficiencies.

Exit Interview was conducted, where this report was discussed with Director.

Report was signed confirming receipt of documents.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Arminder Singh	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2022

LIC809 (FAS) - (06/04)

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