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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420933
Report Date: 11/04/2021
Date Signed: 11/04/2021 04:01:40 PM

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:LIVE, LEARN AND LAUGH PRESCHOOL - SITE IIFACILITY NUMBER:
013420933
ADMINISTRATOR:MARYLAND, TYESHAFACILITY TYPE:
850
ADDRESS:14871 BANCROFT AVETELEPHONE:
(510) 326-1164
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:60CENSUS: 6DATE:
11/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rachel WilsonTIME COMPLETED:
04:15 PM
NARRATIVE
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On 11/04/2021 at 8:30am, Licensing Program Analyst (LPA) Christina Uribe conducted an unannounced Annual Required Inspection and met with Rachel Wilson. LPA Uribe disclosed the purpose of the inspection and was granted entry into the facility by the teacher. Present during the inspection was 6 students, 1 fingerprint cleared staff member (S2), & 1 staff member (S3) who did not have fingerprint clearance resulting in a Type A violation and the immediate removal of that staff member. During the inspection, 5 additional children were dropped off and added to the total number of students present to 11. The center consists of 1 classroom in 1 building. The hours of operation are 8:00a-5:30p, Monday-Friday.

CLASSROOMS: The classroom was inspected. Teacher-child ratio was observed. There are adequate play and learning materials available. There is adequate heating/air conditioning, ventilation, & lighting. The floors, furniture and equipment are age-appropriate and in good repair. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is in the corner of the classroom. At 9:00am LPA Uribe tested one smoke detector located in the hallway and the device was functional. The fire alarm is hardwired into the building. There is no evidence of a carbon monoxide detector and one could not be located. The center is equipped with a working telephone, pull down fire alarms and a fully charged 3A40BC fire extinguisher. All solid waste storage containers have tight fitting covers on and appears to be in good repair.

BATHROOMS & TOILETING AREAS: There are separate bathrooms for staff and children. Toilets and faucets are in safe and sanitary operating condition. The children are able to reach the sinks and toilets. Supplies are available to children.

***Continued on LIC 809C***.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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 14
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: LIVE, LEARN AND LAUGH PRESCHOOL - SITE II
FACILITY NUMBER: 013420933
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(d)
Criminal Record Clearance
(d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview & record review, the licensee did not comply with the section cited above in 1 out of 2 persons which poses an immediate health, safety or personal rights risk to persons in care. S3 was found to have no criminal record/fingerprint clearance.
POC Due Date: 11/05/2021
Plan of Correction
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S3 was immediately removed from the facility as instructed by LPA Uribe to correct the deficiency. Additionally, Licensee will instruct staff member to not return to the facility until a criminal record clearance has been obtained for that individual.
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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 2 of 14
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: LIVE, LEARN AND LAUGH PRESCHOOL - SITE II
FACILITY NUMBER: 013420933
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in identifiers which poses/posed a potential health, safety or personal rights risk to persons in care. S1 & S2 did not have current Mandated Reporter Training Certificates on file.
POC Due Date: 11/19/2021
Plan of Correction
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Licensee will have S1 & S2 staff members complete the Mandated Reporter Training and obtian certificates no later than 11/19/2021. LPA Uribe will return for an inspection and will review files for proof of correction to clear the deficiency.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in identifiers which poses/posed a potential health, safety or personal rights risk to persons in care. S1 & S2 did not have a current Pediatric CPR/First-Aid Certificate on file.
POC Due Date: 11/19/2021
Plan of Correction
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Licensee will have S1 & S2 complete the EMSA 8-hour Pediatric CPR/First-Aid Training and obtain certificates no later than 11/19/2021. LPA Uribe will return for an inspection and will review files for proof of correction to clear the deficiency.
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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 3 of 14
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: LIVE, LEARN AND LAUGH PRESCHOOL - SITE II
FACILITY NUMBER: 013420933
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in identifiers which poses/posed a potential health, safety or personal rights risk to persons in care. S1 & S2 do not have a Health Screening (LIC 503) form on file.
POC Due Date: 11/19/2021
Plan of Correction
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Licensee will have S1 & S2 complete a Health Screening (LIC 503) form and must be signed by both the staff member and their physician no later than 11/19/2021. LPA Uribe will return for an inspection and will review files for proof of correction to clear the deficiency.
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in identifiers which poses/posed a potential health, safety or personal rights risk to persons in care. C1 does not have a completed Physician Report (LIC 701) on file. Additionally, C2 has an incomplete Physician's Report (LIC 701) on file.
POC Due Date: 11/19/2021
Plan of Correction
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Licensee will review all children's files to ensure that each has a completed and signed Physician's Report (LIC 701) no later than 11/19/2021. LPA Uribe will return for an inspection and will review files for proof of correction to clear the deficiency.
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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 4 of 14
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: LIVE, LEARN AND LAUGH PRESCHOOL - SITE II
FACILITY NUMBER: 013420933
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in identifiers which poses/posed a potential health, safety or personal rights risk to persons in care. C1 does not have proof of immunizations on file.
POC Due Date: 11/19/2021
Plan of Correction
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Licensee will obtain proof of immunizations for C1 & review all children's files to ensure all have proof of immunizations no later than 11/19/2021. LPA Uribe will return for an inspection and will review files for proof of correction to clear the deficiency.
Type B
Section Cited
CCR
101223(b)(1)
Personal Rights
(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in identifiers which poses/posed a potential health, safety or personal rights risk to persons in care. C1 & C2 do not have a signed Personal Rights (LIC 613A) form on file.
POC Due Date: 11/19/2021
Plan of Correction
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Licensee will obtain proof of immunizations for C1 & C2 & review all children's files to ensure all have a signed Personal Rights (LIC 613A) form on file no later than 11/19/2021. LPA Uribe will return for an inspection and will review files for proof of correction to clear the deficiency.
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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 5 of 14
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: LIVE, LEARN AND LAUGH PRESCHOOL - SITE II
FACILITY NUMBER: 013420933
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(a)(1)
Sign In and Sign Out
(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation & record review, the licensee did not comply with the section cited above in identifiers which poses/posed a potential health, safety or personal rights risk to persons in care. At 9:00am LPA observed 6 children in care at the facility however at that same time record review showed that only 5 of the children were signed in for the day.
POC Due Date: 11/19/2021
Plan of Correction
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Licensee will review all sign in and out forms within the last month for compliance & will speak with each parent and staff member about properly maintaining sign in and out procedures for children in care each day no later than 11/19/2021. LPA Uribe will return for an inspection and will review files for proof of correction to clear the deficiency.
Type B
Section Cited
CCR
101216.3(b)(1)
Teacher-Child Ratio
(b) The licensee may use teacher aides in a teacher-child ratio of one teacher and one aide for every 15 children in attendance. (1) A ratio of one fully qualified teacher (as specified in Section 101216.1(c) and one aide for every 18 children in attendance in a preschool program is allowed when the aide meets the qualifications specified in Section 101216.2(d).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in [count] out of identifiers which poses/posed a potential health, safety or personal rights risk to persons in care. S2 is the only staff member present at the time of the inspection. LPA reviewed her file and found her to not have the required teacher qualifications for a preschool child care program
POC Due Date: 11/19/2021
Plan of Correction
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Licensee will ensure that at least one fully qualified teacher will be included in the ratio at all times during hours of operation no later than 11/19/2021. Qualifications for a preschool child care facility must be met. LPA Uribe will return for an inspection and will review files for proof of correction to clear the deficiency.
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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 6 of 14
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: LIVE, LEARN AND LAUGH PRESCHOOL - SITE II
FACILITY NUMBER: 013420933
VISIT DATE: 11/04/2021
NARRATIVE
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FOOD SERVICE AREAS: The kitchen is not in use due to COVID-19 as all parents provide lunch and snack food items to children. Dry goods are available for the students who are still hungry after finishing a meal. All food items are stored separately from hazardous materials.

OUTDOOR PLAY AREAS: There are no bodies of water, or free-standing water accessible to children. There are age appropriate toys and materials for the children. The playground outside is fenced and all play structure is secured into the ground. One of the two slides on the play structure is in need of replacement or repair due to a broken piece.

RECORDS: Children’s files and staff files were reviewed around 10:10am. S1 & S2 staff members did not have current Mandated Reporter training certificates, Pediatric CPR/First-Aid Certificates, & Health Screening (LIC 503) on file. Two children's (C1 & C2) files did not have a signed Personal Rights (LIC 613A) on file. C1 did not have a Physician's Report (LIC 701) or record of immunizations on file. C2 did not have the physician sections completed, signed, and dated on the Physician's Report (LIC 701). The center is not in compliance with the sign in and out procedure as LPA Uribe observed 6 children in care at 9:00am however only 5 children were signed in at that time. There are no firearms stored on the premises. All required documents are posted in a publicly accessible area.

HEALTH RELATED SERVICES: LPA Uribe inspected and found that no IMS services were being provided. The center is equipped with a fully stocked first-aid kit and available in the classrooms. It was observed upon arrival that none of the children were wearing face masks indoors which is a violation of Alameda County Public Health Department's mask mandate for children over the age of 2 years while indoors.

***Continued on LIC 809C***

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 12 of 14
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: LIVE, LEARN AND LAUGH PRESCHOOL - SITE II
FACILITY NUMBER: 013420933
VISIT DATE: 11/04/2021
NARRATIVE
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California Law requires Family Child Cares licensees 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 electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The director was reminded that Licensing needs to be informed prior to use of additional areas in the facility.

Facility representative 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. The director was reminded of the responsibility as a mandated reporter. All forms can be downloaded at cdss.ca.gov.

The attached type A violations is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgment form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.

The attached Type B, Technical, & Advisory Violations are cited today and must be corrected by the due date. A complete list of violations cited today are as stated below:

  • Type A Violation: Staff member (S3) did not have eligible fingerprint clearance to be present on the premises.
  • Type B Violation: S1 & S2 do not have current Mandated Reporter Training Certificates on file.
  • Type B Violation: S1 & S2 do not have a current Pediatric CPR/First-Aid Certificate on file.
  • Type B Violation: S1 & S2 do not have a Health Screening (LIC 503) form on file.


***Continued on LIC 809C***
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 13 of 14
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: LIVE, LEARN AND LAUGH PRESCHOOL - SITE II
FACILITY NUMBER: 013420933
VISIT DATE: 11/04/2021
NARRATIVE
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  • Type B Violation: C1 does not have a completed Physician Report (LIC 701) on file. Additionally, C2 has an incomplete Physician's Report (LIC 701) on file.
  • Type B Violation: C1 does not have proof of immunizations on file.
  • Type B Violation: C1 & C2 do not have a signed Personal Rights (LIC 613A) form on file.
  • Type B Violation: At 9:00am LPA observed 6 children in care at the facility however at that same time record review showed that only 5 of the children were signed in for the day.
  • Type B Violation: S2 is the only staff member present at the time of the inspection. LPA reviewed her file and found her to not have the required teacher qualifications for a preschool child care program.
  • Technical Violation: LPA Uribe and facility representative were unable to locate a carbon monoxide detector within the facility.
  • Technical Violation: The slide on the play structure has a broken piece and could pose a safety risk.
  • Technical Violation: In the director's absence, designated representative was unable to access required files or locate a carbon monoxide detector.
  • Technical Violation: No record of the required 16 hours of health and safety training certificate for Licensee.
  • Technical Violation: Not all personnel records were maintained or available to the licensing agency for review.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Rachel Wilson
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC809 (FAS) - (06/04)
Page: 14 of 14