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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420570
Report Date: 04/18/2023
Date Signed: 04/18/2023 02:42:20 PM


Document Has Been Signed on 04/18/2023 02:42 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 ACADEMYFACILITY NUMBER:
013420570
ADMINISTRATOR:YEN NGUYENFACILITY TYPE:
830
ADDRESS:2856 WASHINGTON BLVDTELEPHONE:
(510) 979-9794
CITY:FREMONTSTATE: CAZIP CODE:
94539
CAPACITY:12CENSUS: 11DATE:
04/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:31 AM
MET WITH:Seliya YooTIME COMPLETED:
03:01 PM
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On 4/18/2023, Licensing Program Analyst (LPA) Melanie Otsuji conducted a REQUIRED - 1 YEAR INSPECTION at the facility. LPA met with Director, Seliya Yoo. Also present during today's visit were 3 additional staff members and 11 infant aged children. LPA toured the facility inside and out. Days and hours of operation are Monday through Friday 8:00am to 6:00pm. The facility is licensed to serve a maximum of 12 infants (Birth to 24 months of age). During the inspection, LPA observed the facility to be in compliance with staff supervision and ratio requirements and that all infants were attended to.

LPA observed that the facility is operating within the terms of the license and is in compliance with the approved fire clearance capacity. The facility was observed to be clean, safe, sanitary, and in good repair. Disinfectants, cleaning solutions, and all other items that are dangerous to infants were observed to be securely stored and inaccessible. Furniture and equipment was observed to be safe, in good condition, and free of sharp, loose, or pointed parts during today's inspection. The facility has age appropriate furniture and equipment, including infant cribs, cots, and changing tables within arms reach of a sink. Classroom furniture and equipment for infants were observed to be clean and operable. Infant cots and cribs were observed to be in good condition and cribs were observed without any extra items in them and covered with tight fitting linens.

Bottles brought from home were observed to be properly stored at the appropriate temperature.

See 809-C for continuation of report...
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2023
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: PALM ACADEMY
FACILITY NUMBER: 013420570
VISIT DATE: 04/18/2023
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The outdoor area is surrounded by secured fencing and the outdoor surfaces are safe and age appropriate for infants. LPA observed that sign in/out is electronic via Brightwheel. Facility utilizes Brightwheel to log sleep checks. The facility maintains an updated roster of infants enrolled.

No weapons are stored on site and no bodies of water are on the premises. LPA observed fire extinguishers, smoke detectors, carbon monoxide detectors, a central alarm system, and complete first aid kits throughout the facility. Emergency disaster drills are performed as required, last of which was done October 2022. LPA reminded the Director that all fire safety items and equipment should be maintained at least every 12 months. LPA reviewed a random sample of infant's records and observed that there is a separate, complete, and current record for each infant enrolled in the center. LPA observed that infant needs and service plans are updated at least quarterly as required.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care at this time. IMS Plan of Operation is on file at this time. 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 is reminded that ALL assistants, volunteers, and 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 $3000 per person, per incident. Director was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov
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.

A notice of site visit was given and must remain posted for 30 days. No deficiencies cited during today's inspection. Appeal rights provided and discussed. Exit interview conducted and report was reviewed with Director.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023
LIC809 (FAS) - (06/04)
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