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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420589
Report Date: 02/13/2023
Date Signed: 02/13/2023 01:54:48 PM


Document Has Been Signed on 02/13/2023 01:54 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:A.U.S.D.- WOODSTOCK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
013420589
ADMINISTRATOR:HUNT, VIRGINIAFACILITY TYPE:
850
ADDRESS:500 PACIFIC AVENUETELEPHONE:
(510) 748-4001
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY:120CENSUS: 80DATE:
02/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Virginia Hunt TIME COMPLETED:
02:00 PM
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On 2/13 /2023 at 9:10am, Licensing Program Analyst (LPA) Catherine Fernandes met with Director Virginia Hunt for an Unannounced Required Annual Inspection. Present for the inspection was 80 preschool age children, 17 toddlers and 17 additional staff members. The center follows the Title Five regulations and has a toddler option attached to the license. The teacher- child ratio was being met today. The center was toured for a health and safety inspection. The facility operates from Monday through Friday from 7:00am–6:00pm.

The center operates on the Island High school building with six classrooms. The entrance to the center is on Lincoln avenue. Room numbers eight and seven are for the toddlers, one, twelve, three and two are for the preschoolers. The surfaces, furniture and equipment appear to be safe, sanitary and in good repair. The heating, lighting and ventilation is adequate. There is a total of eight toilets, two urinals and 20 sinks available for the children which are sanitary and in operational conditions. There are supplies available for the children to wash and dry their hands. There are two separate bathrooms for staff. The activities and toys appear to be age appropriate for the children in care. The outside play area is fully fenced with shaded areas for the children. There is play structure that is sturdy and anchored into the ground, there are wood chips for cushioning to absorb the impact from a fall. The center has a separate outdoor play area for the toddlers. LPA did not observe any bodies of water, free standing water, cleaning supplies, or toxic items accessible to children during today’s inspection. The center prepares and provides snacks to the children while in care and lunches are brought from an outside vendor. The kitchen area was maintained in a clean manner. There is a current menu posted for the month. The center is providing 1% milk to children in care. The children have their own cubes and hooks to store personal belongings. All the children have personal water bottles, access to clean drinking water through a hydration station and teachers have a pitcher of water in each classroom that is brought outside while outdoors. The center has conducted their lead testing and will not be using the classrooms four and 13 due to the exceeded amount of lead. The fire system is hardwired. Each classroom has a working carbon monoxide detector and a fully charged fire extinguisher.



Report continued on 809C
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: A.U.S.D.- WOODSTOCK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013420589
VISIT DATE: 02/13/2023
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 All proper postings are made visible by the front of the center’s entrance. The fire/disaster drill log was complete with the last drill logged 1/25/2023. A physical census of the children and staff were taken and cross referenced with the sign-in and out log. All children were accounted for and properly signed in. LPA obtained the center’s facilities’ files and reviewed 10 children’s files seven staff files. LPA obtained a copy of the children’s roster and an updated Personnel report. During the walk through LPA observed dark stains in the classroom's carpet.

Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities 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 email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

This facility provides Incidental Medical Services, however NO IMS is being provided as of today’s date. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 web page 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.

Report continued on 809C

SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: A.U.S.D.- WOODSTOCK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013420589
VISIT DATE: 02/13/2023
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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

See 809D for deficiency

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

Exit interview conducted and reviewed with the Director Hunt


Report and Appeal Rights provided
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 02/13/2023 01:54 PM - It Cannot Be Edited

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, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: A.U.S.D.- WOODSTOCK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 013420589

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.3(b)
Indoor Activity Space
(b) The floors of all rooms shall have a surface that is safe and clean.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above the classroom carpets have dark stains throughout, which poses a potential health and safety risk to persons in care.
POC Due Date: 03/01/2023
Plan of Correction
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The center will come up with a plan to ensure all floors are clean and safe before the POC date and send the plan to CCLD.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Catherine FernandesTELEPHONE: (510) 725-7002
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023
LIC809 (FAS) - (06/04)
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