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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422420
Report Date: 10/28/2022
Date Signed: 10/28/2022 04:32:25 PM


Document Has Been Signed on 10/28/2022 04:32 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:LA PLAZITA PRESCHOOL IIIFACILITY NUMBER:
013422420
ADMINISTRATOR:LOPEZ, ETELVINAFACILITY TYPE:
850
ADDRESS:3616 - 3636 35TH AVE.TELEPHONE:
(510) 857-7309
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:110CENSUS: 65DATE:
10/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Etelvina LopezTIME COMPLETED:
04:40 PM
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On October 28, 2022 at approximately 9:05am, LPA Haderer arrived unannounced for an annual inspection for compliance to Health and Safety. The new CARE tool was used for the inspection. Present for the inspection was the site director Etelvina Lopez, 20 teachers and staff with 65 children in care (2 years to 5 years old). Hours of operation are Monday to Friday 7:00am to 6:00pm. The school is in ratio today.

The child care center operates in 4 buildings, A, B, C and D. There are 7 classrooms: Verde; Café; Morado; Anaranjado; Amarillo; Rojo and Azul. LPA observed that all preschool rooms are clean and safe for all children and staff. Children bring their own water from home and the facility uses tap water for children (lead testing is currently in process; results are expected soon). Water is brought outside for the children.



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 was one jug of cleaning chemical and a jug of hand soap on a low shelf in one of the children’s bathrooms in the Anaranjado classroom, see LIC809D for deficiency. There were no other hazardous items/toxins observed to be accessible to children in care today. There are no bodies of water accessible to children in care.

LPA observed solid waste containers with tight-fitting lids. Classrooms have a fully charged 2A10BC fire extinguishers, the last annual inspection was done 8-22-2021. On March 30, 2022 Oakland Fire Department completed an inspection and full system test of the fire alarm system. The test passed / approved, and an updated fire clearance was granted. Carbon monoxide detectors were available and tested. Heating and ventilation in the classrooms are acceptable. Disaster drills are conducted every month (each building has their own schedule, and all of them conduct monthly drills), the last drill was done on October 20, 2022.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
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: LA PLAZITA PRESCHOOL III
FACILITY NUMBER: 013422420
VISIT DATE: 10/28/2022
NARRATIVE
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The facility has children that need incidental medications (EpiPens and inhalers). All medications are stored in each classroom in high cupboards. Medications were checked and all have required signed parental forms granting permission to administer the medication. There were no expired medications found.

The playground areas are in safe condition and free from sharp, loose or pointed parts. The areas around or under high climbing equipment has appropriate rubber cushioned material that absorbs a fall and enclosed within the school property, surrounded by a secure fence. Ample shade is available for the children in the play areas and teachers are always present. During Covid, to increase outdoor space for children the school expanded the playground area on the south side of the campus. LPA inspected the new area and found it to be surrounded by a 5-foot wooden fence and properly secured. There was shade, and soft mats for children to play on and some small and safe child structures. Teachers are always present with the children when in the area. LPA found the area to be safe and secure.

There are appropriate children’s bathrooms with toilets and hand washing sinks. There are also additional sinks available in classrooms with cold water taps. For any children that need to be changed, there are changing tables within an arm’s length of the sink. All sinks have functioning water taps with appropriate hand washing signs. There are enough towels and soap supplies. All toilets, hand washing and cleaning areas are in safe and sanitary operating condition.

LPA observed sufficient cots for the children. Site Director confirmed that bedding is taken home and washed by the parents each week. Classrooms have trash cans with tight fitting cover for the disposal of solid waste. Children bring their own lunch from home, the facility provides snacks. There were separate staff bathrooms not used by the children. Director stated that there are no weapons or firearms on the premises. The sign in/out sheets were reviewed and are accurate.

Children's records were reviewed, LPA requested and took a copy of the facility roster. All files selected were complete and in very good order.
Staff files were reviewed. Opening and closing staff have current CPR and first aid training. All staff subjected to criminal review have been cleared and associated to the facility. Files were found to be incomplete. Missing items included LIC503 Health Screening reports; Immunization records for measles, pertussis and TB; and Mandated Reporter certificate. See LIC809D for deficiencies.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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: LA PLAZITA PRESCHOOL III
FACILITY NUMBER: 013422420
VISIT DATE: 10/28/2022
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All documents required to be posted were appropriately posted on the walls: License; Emergency Disaster Plan; Earthquake Preparedness checklist; Notification of Parents Rights; Personal rights; Child seatbelt laws; menus; daily activity schedules. There is a waiver (prominently posted) for this facility for playground space to be alternated to limit the number of children to a maximum never to exceed 93 children.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

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.

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 4 deficiencies issued today, SEE LIC809D for details:


- Chemical Cleaner and hand soap was accessible to children.
- Staff files were missing LIC503 Health Screening report (including TB)
- Staff files were missing proof of measles, pertussis immunization
- Staff file was missing Mandated Reporter certificate

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 Etelvina Lopez.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 10/28/2022 04:32 PM - It Cannot Be Edited

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: LA PLAZITA PRESCHOOL III
FACILITY NUMBER: 013422420

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that a jug of cleaning chemical and a jug of hand washing soap was found on a low shelf in a children's bathroom which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2022
Plan of Correction
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Site Director immediately moved both jugs to a safe location out of the reach of children.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 2 staff files were missing proof of measles and pertussis immunization (or proof of immunity) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/11/2022
Plan of Correction
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Staff will get immunization completed and submit proof of completion.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6


Document Has Been Signed on 10/28/2022 04:32 PM - It Cannot Be Edited

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: LA PLAZITA PRESCHOOL III
FACILITY NUMBER: 013422420

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 1 staff file was missing proof of completing Mandated Reporter Child Care Provider AB1207 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/31/2022
Plan of Correction
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Staff member will complete the Mandated Reporter training (General if needed) and Child Care Provider AB1207.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 2 staff files did not contain LIC503 Health Screening Report (including test for TB) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/25/2022
Plan of Correction
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Staff will provide proof of health screening or make a new appointment with their doctor to complete the screening. Going forward, no new staff will be allowed to start work until this screening is complete (or within 7 days of start date).

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
LIC809 (FAS) - (06/04)
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