013420570-2-11-2022-52-CC-MOTI-CBJSUU-20220211131143

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420570
Report Date: 02/11/2022
Date Signed: 02/11/2022 01:11:50 PM

Document Has Been Signed on 02/11/2022 01:11 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	PALM ACADEMY		FACILITY NUMBER:	013420570
ADMINISTRATOR:	YEN NGUYEN		FACILITY TYPE:	830
ADDRESS:	2856 WASHINGTON BLVD		TELEPHONE:	(510) 979-9794
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY:	12	CENSUS: 5	DATE:	02/11/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Chantel Blas		TIME COMPLETED:	01:29 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 2/11/2022, Licensing Program Analyst (LPA) Melanie Otsuji arrived at the facility unannounced to conduct a REQUIRED - 1 YEAR INSPECTION. LPA was met by Director, Chantel Blas. Present for this inspection are the Director, 2 additional staff members and 5 infant aged children. The facility was toured to conduct a Health and Safety Inspection. LPA toured facility classrooms. The facility consists of the infant play room, sleep room and kitchen/eating area. Also on site are a preschool program and school age program. The facility is tidy and clean with heating and ventilation for safety and comfort. There are toys and learning materials in the facility. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture and equipment accessible to children were observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. The Director is aware that baby walkers, bouncers, exersaucers, and jumpers are not allowed in licensed care facilities. LPA toured food preparation area. Food preparation area was found to be free of litter, garbage, and evidence of rodents or other vermin. Food is protected from contamination and, per staff, contaminated food is discarded immediately. Food/beverages capable of rapid spoiling are properly stored. Bottles, dishes and containers of food brought by the infants’ authorized representatives are labeled with infant’s name. The infant changing tables are placed within arm’s reach of a sink while in use. Uncontaminated drinking water is available to children inside the facility.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: PALM ACADEMY	FACILITY NUMBER: 013420570
	VISIT DATE: 02/11/2022

NARRATIVE

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LPA toured outdoor play area. Outdoor play areas were found to be in safe condition during this inspection. All play equipment is operable and age-appropriate at this time. The facility has a fully charged 3A40BC fire extinguisher, working smoke detector, working carbon monoxide detector, and working telephone. Multiple staff present today have current CPR/1st Aid certificates. The facility is in ratio today, with one teacher supervising no more than 4 infants. Children were observed to be visually supervised at all times, with no infants being left unattended. Children's files and staff files were reviewed for proper documentation. All required forms are posted in public view, including menus. Facility roster was obtained.

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.”

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.

There are no deficiencies cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director. Appeal rights were provided to the Director and the signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022

LIC809 (FAS) - (06/04)

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