013421426-9-2-2021-52-CC-EWOS-C6GMEH-20210902093245

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421426
Report Date: 09/02/2021
Date Signed: 09/02/2021 09:32:55 AM

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:	HUSD - PARK STATE PRESCHOOL		FACILITY NUMBER:	013421426
ADMINISTRATOR:	BLANCH, LINDA		FACILITY TYPE:	850
ADDRESS:	411 LARCHMONT ST		TELEPHONE:	(510) 723-3875
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	24	CENSUS: 11	DATE:	09/02/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Mitchell Ha		TIME COMPLETED:	09:45 AM

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 September 2, 2021 at 08:15 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced Annual Required Inspection and met with Assistant Director, Mitchell Ha. LPA disclosed the purpose of the inspection and was granted entry into the facility by the director. There were eleven (11) children present during this inspection and two (2) additional staff members. The facility was toured for a health and safety inspection. Hours of operation are 8:15 AM to 11:15 AM for morning session, and 12:15 PM to 3:15 PM for afternoon session. CLASSROOMS: This center operates out of classroom five (5). The floors are free of tripping hazards, and the furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation, lighting, and the center has play and learning materials available for children. There is proper individual storage space for each child. The isolation area for sick children is the isolation tent on the playground. Drinking water is available inside and outside of the center. There's are a fully charged 3A40BC fire extinguishers in the classroom, functioning carbon monoxide detector, and wired smoke detectors throughout the facility. All solid waste storage containers have tight fitting covers on, and appear to be in good repair. BATHROOMS AND TOILETING AREAS: There are separate bathrooms for staff and children. Supplies are available to the children. Toilets and faucets are in safe and sanitary operating condition and the children are able to reach the sinks and toilets. See 809-C.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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: HUSD - PARK STATE PRESCHOOL	FACILITY NUMBER: 013421426
	VISIT DATE: 09/02/2021

NARRATIVE

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FOOD SERVICE AREAS: Breakfast and lunch is supplied by the school and there are no menus posted at this time.

OUTDOOR PLAY AREAS: The playground area is fully fenced and all equipment and surfaces are safe and free from hazards. There are age appropriate toys and materials for the children. There’s a shaded rest area for children in care, and no bodies of water, or free standing water accessible to children.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Four (4) children's file were reviewed. Staff files are maintained and stored in the Hayward School Districts Human Resource Office, and all licensing requirements for personnel are met as a condition of employment with the school district. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. The center is in compliance with the sign in and out procedure.

Disaster drills are being conducted at least once every 6 months in conjunction with the Hayward Unified School District schedule. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: No IMS is being provided at this time and no medication is being stored at this facility. The center is equipped with a fully stocked first aid kit located in the classroom.

California Law requires Child Care Centers 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.

See 809-C

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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: HUSD - PARK STATE PRESCHOOL	FACILITY NUMBER: 013421426
	VISIT DATE: 09/02/2021

NARRATIVE

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Director is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Director was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing 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

No deficiency cited during today’s visit. A Notice of Site visit was posted at time of inspection and must remain posted for 30 days. Exit interview conducted with the assistant director. A copy of the report was provided

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika Woods	TELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC809 (FAS) - (06/04)

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