013421414-8-26-2021-52-CC-RHAR-C69QT2-20210826122625

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421414
Report Date: 08/26/2021
Date Signed: 08/26/2021 12:26:38 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:	FRIENDS OF CHILDREN WITH SPECIAL NEEDS		FACILITY NUMBER:	013421414
ADMINISTRATOR:	LUO, XIAOYAN		FACILITY TYPE:	840
ADDRESS:	2190 PERALTA BLVD		TELEPHONE:	(510) 739-6900
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	30	CENSUS: 0	DATE:	08/26/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Xiaoyan Luo		TIME COMPLETED:	12:35 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 August 26, 2021 at approximately 8:50am Licensing Program Analyst (LPA) Russ Haderer arrived to conduct an unannounced random annual site inspection for this school-age facility. LPA met with Program Coordinator Ana Adriano and toured all areas licensed for use by children in care for a health and safety inspection. Also arriving at approximately 10:00am was facility director, Xiaoyan Luo who joined in the tour. There were no children present (they arrive starting at 2pm). All adults present are background cleared and associated to this facility. The facility is operated on church property (rented space) and in conjunction with other licensed programs. The facility rooms include the church sanctuary, 2 attached rooms and an outside playground area. The playground has an approved waiver that restricts the area to 21 children at a time. All play equipment is in safe condition and free from sharp, loose or pointed parts. Shade was available in the play areas and teachers are always present. There is a kitchen that is not used by the facility and is off limits to children made inaccessible by a closed door. The facility has a fully charged 3A40BC fire extinguisher, the last annual inspection done in March 31, 2021. There is a working carbon monoxide detector and smoke alarms (tested and working). Heating and ventilation was acceptable. Due to the pandemic, the school does not provide any snacks, children bring their own (including their own water bottles). There is a menu posted showing snack times. The facility is clean and well organized with ample age appropriate furnishings and equipment. Surfaces including floors and counter tops are clean and toxic free. There were no hazardous items/toxins observed to be accessible to children in care today. There are no bodies of water accessible to children in care.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: FRIENDS OF CHILDREN WITH SPECIAL NEEDS	FACILITY NUMBER: 013421414
	VISIT DATE: 08/26/2021

NARRATIVE

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Disaster drills are conducted every six months, the last drill was conducted on August 19, 2021.
There are two children’s bathroom with two toilets and two sinks. The sinks have functioning water taps with appropriate hand washing signs. There are enough towels and soap supplies. All toilets, handwashing and cleaning areas are in safe and sanitary operating condition.

The sign in/out sheets were reviewed. Classrooms have touchless trash cans with tight fitting cover for the disposal of solid waste. The facility does not have any children that require incidental medication (EpiPen’s, inhalers and anti-histamines for allergies).

At approximately 10:30am LPA performed children's record reviewed: LPA requested and reviewed facility roster. All files selected were complete and up to date.

At approximately 11:00 am LPA performed staff file review. All staff subjected to criminal review have been cleared and associated to the facility. All files were complete and some employees Mandated Reported has expired, and otherwise all were found to be in compliance with Title 22 regulations.

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

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: FRIENDS OF CHILDREN WITH SPECIAL NEEDS	FACILITY NUMBER: 013421414
	VISIT DATE: 08/26/2021

NARRATIVE

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Site 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.

No deficiencies were found at facility during today’s inspection. A copy of this report to remain on file for 3 years.

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 Xiaoyan Lou.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

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