<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422450
Report Date: 02/20/2020
Date Signed: 02/20/2020 03:39:35 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:LARPD EXTENDED STUDENT SERVICES - PORTOLAFACILITY NUMBER:
013422450
ADMINISTRATOR:DENSBERGER, ERICAFACILITY TYPE:
840
ADDRESS:2451 PORTOLA AVE.TELEPHONE:
(925) 960-2483
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY:120CENSUS: 70DATE:
02/20/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Irish Marshall & Erin MontemayorTIME COMPLETED:
04:15 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
At 2/20/2020 Licensing Program Analyst (LPA), Leslie Ibo, conducted an unannounced random inspection to the facility. LPA met with center Lead teacher’s Irish Marshall & Erin Montemayor and explained the nature of today's visit. Also meet with Youth Service Coordinator Brenda Rios. At 3:28 PM there were 7 staffs including youth service coordinator with 70 children total . LPA toured the Facility both inside and outside during today's visit. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan, (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule.

During today's inspection the school aged program was utilizing 3 classrooms (18,19,20). At 1:35PM 20-day care children arrived at the facility, children were using room 20, during the inspection there were 2 teachers in the classroom.

...Continued on LIC809-C...

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Leslie IboTELEPHONE: (510) 622-2646
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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: LARPD EXTENDED STUDENT SERVICES - PORTOLA
FACILITY NUMBER: 013422450
VISIT DATE: 02/20/2020
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
A review of staff records on indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions from the school district.
LPA reviewed children and staff files during today's visit. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). The staff files reviewed contains the required transcripts/verification of experience. The new immunization requirement (pertussis, measles, and flu vaccines) for all Licensees and staff, volunteers that work directly with the children was present is the files. Youth Service Coordinator Brenda Rios has CPR and First Aid certifications on file with expiration date of 2/12/2021. Youth service coordinator understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips).

LPA’s observed that the teacher/child ratio was in compliance during today's visit. Youth Service coordinator understands the conditions, limitations, and capacity specifications of the facility license. Brenda Rios understands that children shall always be visually supervised.

LPA’s observed that all rooms are clean and safe for all children and staff. Children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children.



The food preparation and storage areas are clean. All food and beverages that require refrigeration are stored in covered containers. Any medications at the facility are stored in the office. At 2:19 PM LPA checked the medication storage, there were 2 medications found, these medications was not expired during the inspection. First Aid kit was also checked. LPA's observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. Drinking water is readily available for the children inside the facility and in the outdoor playground.
LPA's observed that the outdoor equipment is age appropriate. There are enough resilient materials in the outdoor playground area. LPA’s did not observe any bodies of water.

NO deficiency cited during todays inspection.

Exit interview was conducted with Brenda Rios.



A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Leslie IboTELEPHONE: (510) 622-2646
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2