013422456-7-8-2022-52-CC-KPHN-CG5RV5-20220708132058

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422456
Report Date: 07/08/2022
Date Signed: 07/08/2022 01:21:10 PM

Document Has Been Signed on 07/08/2022 01:21 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:	OLIVE CHILDREN AT ST. JAMES CATHOLIC CHURCH		FACILITY NUMBER:	013422456
ADMINISTRATOR:	KWEIWHEI (JONI) JEN		FACILITY TYPE:	850
ADDRESS:	34700 FREMONT BLVD.		TELEPHONE:	(510) 770-4999
CITY:	FREMONT	STATE: CA	ZIP CODE:	94555
CAPACITY:	60	CENSUS: 37	DATE:	07/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Carmina Harris		TIME COMPLETED:	01:45 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 07/08/2022 approximately at 8:45am, Licensing Program Analyst (LPA) Kelly Phan met with Carmina Harris (Preschool Director) for an unannounced required 1 year inspection. The facility is located on the premises of St James Catholic Church. Present for this inspection are 24 preschool aged children and 13 school aged children, along with 6 fingerprinted and associated staff members. The facility is in ratio today. Facility operating hours are 8:00 am to 6pm Monday -Friday. The facility was toured to conduct a health and safety inspection. At 9:00am, LPA toured the daycare areas such as 2 bathrooms (1 for girls and 1 for boys), main daycare area, fenced play area, isolation area, and one of the rooms that is used for summer camp. Per center director, as a COVID precaution, families are being asked to drop off the children at the front of the facility to ensure handwashing and temperature checks are in place to prevent COVID exposures. The classroom is tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the classroom. There were no hazardous materials and toxins present during today's inspection. Both bathrooms have plenty of paper towels and soap and working toilets; there is also a separate area designated for toddlers that consists of a changing table and extra pull ups available. Safe drinking water is available to children inside and outside the facility as children are bringing their own water bottles to use. The fenced play area had age appropriate equipment and is inspected everyday; per director, the sand area is inspected every Monday for suspected hazardous and sharp items. LPA observed requiring documents are posted for public review including a facility menu. The food preparation area is clean and does not have any toxic substances. Facility provides breakfast, AM and PM snacks and lunch to children in care. At 10:00AM, LPA reviewed 6 staff files and 10 children files and found them to be complete; there were two staff files that had missing health screening forms and needed updated mandated reporter training. LPA observed there is a waiver for the sign in/sign out sheet where the provider is using an electronic system to capture parent's signatures. SEE LIC 809 C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: OLIVE CHILDREN AT ST. JAMES CATHOLIC CHURCH	FACILITY NUMBER: 013422456
	VISIT DATE: 07/08/2022

NARRATIVE

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There are fully charged fire extinguishers, working telephone, carbon monoxide and smoke detectors that were inspected by Johnson Controls on 06/09/2022. a fire drill was also last conducted and documented on 04/14/2022. The facility also has a fully equipped first aid kit; prescription and non-prescribed medications are stored in the facility closet with the child's name; LPA observed that there were some medications that were expired; per director, the medications belong to a child who does not attend there any longer; LPA also mentioned to have LIC 9221 form for both prescribed and non-prescribed medications, to have medications in their original containers that is not altered. LPA observed that both in the food preparation area and in different corners of the facility there are several allergy list for specific children. Facility is complying with the sleep log requirement as it is being recorded through an electronic app every 15 minutes; LPA reminded director to document any unusual observations and the child's sleeping position on the sleep log.

There is one deficiency were cited for today's inspection:
LPA verified and conducted a file review through Guardian that one of the staff member does not have eligible clearance. Type A citation was issued along with a civil penalty of $500.00. SEE LIC 809D.

LPA Kelly PHAN informed director Carmina that this report dated 07/08/2022 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Kelly PHAN informed the director to provide a copy of this licensing report dated 07/08/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SEE LIC 809 C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/08/2022 01:21 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: OLIVE CHILDREN AT ST. JAMES CATHOLIC CHURCH	FACILITY NUMBER: 013422456
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101170(e)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as 1 staff member does not have eligible background clearance at the facility, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/08/2022
	Plan of Correction
1 2 3 4	Director would ask her staff member to do her LiveScan today (07/08/2022) Director would send proof of completed LiveScan to LPA by 07/11/2022

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: OLIVE CHILDREN AT ST. JAMES CATHOLIC CHURCH	FACILITY NUMBER: 013422456
	VISIT DATE: 07/08/2022

NARRATIVE

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LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. The facility is following and have developed IMS plan on file. When any changes to the IMS plan is made, an updated 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.”

Licensee was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

SEE LIC 809 C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: OLIVE CHILDREN AT ST. JAMES CATHOLIC CHURCH	FACILITY NUMBER: 013422456
	VISIT DATE: 07/08/2022

NARRATIVE

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Licensee was reminded that California Law requires licensed Child Care Centers 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. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

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/process.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

LIC809 (FAS) - (06/04)

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