013421377-4-13-2023-02-CC-MGUT-CQUVMQ-20230413163356

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421377
Report Date: 04/13/2023
Date Signed: 04/13/2023 04:34:27 PM

Document Has Been Signed on 04/13/2023 04:34 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:	PACIFIC RIM INTERNATIONAL SCHOOL		FACILITY NUMBER:	013421377
ADMINISTRATOR:	KUANG, YAN HUA		FACILITY TYPE:	830
ADDRESS:	5521 DOYLE ST		TELEPHONE:	(510) 601-1500
CITY:	EMERYVILLE	STATE: CA	ZIP CODE:	94608
CAPACITY:	24	CENSUS: 8	DATE:	04/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Sandy Fong		TIME COMPLETED:	03:15 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 04/13/2023 Licensing Program Analyst (LPA) Melissa Guirit made an unannounced required annual inspection at the above facility. LPA was met by Administrative Director, Sandy Fong. Present for the inspection were three staff and eight infants. The entire facility was toured to conduct a health and safety inspection. Facility operates Monday through Friday from 8:00am-6:00pm. LPA toured the premises with Director. The infant program operates in the same building as the preschool component, in two classrooms. Per Director, one classroom is not being utilized at the moment. There is a separate area for crib aged children. There was one crib available for crib-aged children to utilize. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Changing tables available for infants are in arms reach of a sink inside the infant classrooms and were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers and were in good repair. LPA observed multiple Fire extinguishers, combination smoke and Carbon Monoxide Detectors. The last Fire Drill was conducted on 3/20/2023. Director is reminded that fire drills should be conducted at least every 6 months. The center is equipped with a fully stocked first aid kit and working telephone. Facility does not provide transportation for infant children, but Director understands that children cannot be left alone, unattended in parked vehicles. Facility’s License, Parents’ Rights Poster PUB 393, Personal Rights, and Activity Schedules were observed to be posted. Parents and facility provide food for the children. Per Director, formula is provided from home. Outdoor playground was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards. Areas around the outdoor play yard are cushioned with material that absorbs falls. Shade is provided by way of covered areas. There were no bodies of water observed during today's inspection. See 809-C for continuance.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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: PACIFIC RIM INTERNATIONAL SCHOOL	FACILITY NUMBER: 013421377
	VISIT DATE: 04/13/2023

NARRATIVE

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Drinking water is arranged to be readily available to children during indoor and outdoor activities. Isolation area for sick children will be in the office. Children sign in and out procedures and logs were reviewed. Facility uses electronic in/sign out procedure. LPA reminded facility to maintain sign in/sign out procedures and make sure parents/authorized representatives sign the child in and out. Staff files were reviewed and contained required documents. Two children's files were reviewed. At least one staff member has a valid CPR/First Aid Training certificate. Staff personnel report was reviewed. A copy of staff and children's roster was provided to LPA by Director, Sandy Fong.

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.
On or before March 30, 2018 any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

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/ction-process.

There are no deficiencies cited today. Exit interview conducted and report was reviewed with Director, Sandy Fong. A Notice of Site Visit was given and must remain posted for 30 consecutive days.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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