013421992-11-9-2021-52-CC-MOTI-C8LURE-20211109144837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013421992
Report Date: 11/09/2021
Date Signed: 11/09/2021 02:48:43 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:	CAPE - FREDERIKSON		FACILITY NUMBER:	013421992
ADMINISTRATOR:	CERVANTES, CELIA		FACILITY TYPE:	850
ADDRESS:	7243 TAMARACK DRIVE		TELEPHONE:	(925) 443-3434
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	20	CENSUS: 0	DATE:	11/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:14 PM
MET WITH:	R. Garcia, J. Fleck and C. Cervantes		TIME COMPLETED:	03:05 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	Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility announced on today's date, 11/09/2021, to conduct a REQUIRED 1 YEAR, CAPACITY INCREASE/ROOM & YARD CHANGE inspection. LPA was met by Interim Executive Director, Regina Garcia, Child Development Manager, Jessica Fleck and Director Celia Cervantes. Facility is currently closed due to the move therefore no children and staff were present. This program's hours of operation are: Monday through Friday 9:00AM - 3:30PM in classroom B101 on the campus of Dublin Unified School District's Frederikson Elementary School Campus. THIS IS A TITLE V FACILITY. Facility is requesting to move from R-2 into B101. Facility is also requesting to increase from licensed capacity of 20 to 24. A health and safety inspection was conducted inside and outside and the measurements are as follows: INDOORS: 955 square feet = 27 children OUTDOORS: 6169.10 square feet = 82 children The center has obtained an approved fire inspection clearance from the Dublin Fire Prevention Services on 10/19/2021. The preschool rooms are equipped with varied age appropriate materials and equipment. There are 2 toilets and 2 sinks available for children. Staff toilet is located in the kindergarten hallway. LPA observed disinfectants, cleaning solutions and other items which are dangerous to children are kept inaccessible to children in care. Furniture and playground equipment are in good condition, free of sharp, loose or pointed parts. Surface areas of outdoor activity space are maintained free of hazards. Toilets and hand washing facilities are in safe and sanitary operating condition. Kitchen area was kept clean, free of litter. Food was observed to be protected against contamination. Facility provides AM/PM snacks and lunch is catered. All storage containers for solid waste had tight-fitting covers that were kept on and in good repair. Drinking water is readily available both inside and outside. Carbon Monoxide detector, smoke detector and fire extinguisher were observed to be in operable condition.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

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: CAPE - FREDERIKSON	FACILITY NUMBER: 013421992
	VISIT DATE: 11/09/2021

NARRATIVE

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On today's date, LPA reviewed (1) personnel files and (5) children's files. Record review indicates that all staff present during today's visit have the proper criminal record clearance/exemption on file. At least one person trained in CPR and Pediatric First Aid is present while children are in care. Personnel files contained a health screening. Required personnel have current mandated reporter training and current immunizations on file. The person who signs the child in/out uses their full legal signature and records the time of the day. Children's files contained the required emergency identification information, menus were observed to be posted at least one week in advance in a place visible by the child's authorized representative.

This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Zero Tolerance policies were explained. The center was found to be clean, safe, sanitary, and in good repair.

A license for 24 preschool children (operating out of 1 room B101), in addition to approval of room B101 and new play yard will be issued and effective on today's date, 11/9/2021. No deficiencies noted on today's date.

An exit interview was conducted was Director, Celia Cervantes. Appeal rights provided and Notice of Site Visit.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

LIC809 (FAS) - (06/04)

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