013421414-7-28-2022-52-CC-RHAR-CGRVN9-20220728163445

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421414
Report Date: 07/28/2022
Date Signed: 07/28/2022 04:34:52 PM

Document Has Been Signed on 07/28/2022 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 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: 5	DATE:	07/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Xiaoyan Luo		TIME COMPLETED:	04:40 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 July 28, 2022 at approximately 1:30pm Licensing Program Analyst (LPA) Russ Haderer arrived unannounced to conduct an annual site inspection for health and safety. LPA met with the Site Director Xiaoyan (Yan) Luo and toured all areas licensed for use by children in care. At arrival there were 5 children in care, 3 more arrived during the inspection. 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. There is a kitchen that is not used by the facility and is off limits to children and made inaccessible by a closed and locked door. The facility has a fully charged 3A40BC fire extinguisher on the kitchen counter, and in the sanctuary, the last annual inspection was done on April 14, 2022. There is a working smoke alarm and carbon monoxide detector (tested and working). Disaster drills are conducted at least every six months, the last drill was done on May 18, 2022. Heating and ventilation is acceptable. There is one children’s bathroom with one urinal and one toilet and two sinks, and a separate staff 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. 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).

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022

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 2

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: 07/28/2022

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
26
27
28
29
30
31
32

Due to the pandemic, the school does not provide any snacks, children bring their own, including their own water bottles. There is a menu 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. The sign in/out sheets were reviewed and found to be complete.

Children's files were reviewed and found to be complete and in good order. A facility roster was provided and a copy was taken. Employee files were reviewed and found to be complete and in good order and in accordance with Title 22 regulations.

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.

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/inspection-process.

There were no deficiencies found during the inspection today.

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

Exit interview conducted and report was reviewed with the site director Xiaoyan Luo.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell Haderer	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2