013423059-2-21-2020-02-CC-CCON-BLZS55-20200221123346

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423059
Report Date: 02/21/2020
Date Signed: 02/21/2020 12:33:57 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ORCKIDS PRESCHOOL		FACILITY NUMBER:	013423059
ADMINISTRATOR:	SHAFIEI, MEHDI		FACILITY TYPE:	850
ADDRESS:	1370 MARIN AVE		TELEPHONE:	(510) 926-7745
CITY:	ALBANY	STATE: CA	ZIP CODE:	94706
CAPACITY:	52	CENSUS: 8	DATE:	02/21/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Fatemeh B. Khovasani		TIME COMPLETED:	12:48 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 Caroline Colson met with Fatemeh (Sheila) B. Khovasani, Head Teacher, for a random annual inspection at 9:20 AM. There are three classrooms, downstairs bathroom and meal area for the entire program. The second floor includes two offices, kitchen, two staff bathrooms and two storage rooms. Present in the facility were 8 children and 2 staff members. Director Mahta Marashi arrived during the inspection at 10:30 AM. Two children's records and two staff records were reviewed by the LPA and the licensee on 02/21/20 at 10:31 AM. C1 and C2 have complete files. S1 and S2 are missing health screening reports. The Licensee stated to the analyst that there are no additional records available in the facility. A physical census was taken of all children present and crossed referenced with the sign in and out sheets. CLASSROOMS: The entire center was inspected. There are adequate play and learning materials available. Furniture and equipment is age appropriate and in good repair. There is adequate heating, ventilation and lighting. There are water bottles for each child. There is a working telephone on site. There is proper individual storage space for each child. There are separate bathrooms for staff and children. The staff bathroom is located upstairs near the director's office. The isolation area for sick children is the director's office. The isolation bathroom is the staff bathroom. BATHROOMS AND TOILETING AREAS: Toilets and faucets work properly. The children are able to reach the sink and toilets. Toilet paper, soap, and paper towels are all available to the children. Adequate lighting is provided in both bathrooms. Bathrooms have cold and warm water available to the children. INSPECTION OF FOOD SERVICE AREA: The facility provides breakfast, lunch and dinner each day. Also, the facility has additional snacks for children. INSPECTION OF OUTDOOR PLAY AREA: There are age appropriate toys and materials for the children. They is a large play structure and many other play equipment available for use. HEALTH RELATED SERVICES: Director states that there are no medications stored at the center. Earthquake emergency items are available in the meal area. The first aid kit is complete. Pediatric CPR and First Aid certificates are current and expire on November 31, 2021. RECORDS: Required forms were posted in an public accessible area. See LIC 809 C for additional information

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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: ORCKIDS PRESCHOOL	FACILITY NUMBER: 013423059
	VISIT DATE: 02/21/2020

NARRATIVE

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RECORDS: Immunization records will be sent to our department within 30 days.

This facility is not providing Individual Medical Services - IMS at this time. LPA discussed IMS services and the requirement to update the plan of operation. Specifics on the plan can be found in the child care center evaluator manual (CCC EM) Policy 101173.

The childcareadvocatesprogram@dss.ca.gov is the email address for the applicant to sign up to receive PINS.

Licensee was asked to go to our website at www.ccld.ca.gov to ensure that she is informed of all new laws and regulations.

A site notice was posted. An exit interview was conducted. Appeal rights were discussed and given. This report must remain available for public review for 3 years.

The attached type B deficiency is being cited today and must be corrected by the due date.

Please See LIC 809 D for Deficiency

SUPERVISOR'S NAME: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

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: ORCKIDS PRESCHOOL	FACILITY NUMBER: 013423059
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/23/2020 Section Cited	1 2 3 4 5 6 7	Personnel Requirements Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:
	8 9 10 11 12 13 14	S1 and S2 don't have health screening reports. This requirement was not met as evidenced by observation and records review conducted during today's inspection. The licensee failed to ensure all staff have the required health screening reports. This poses an potential risk to the health, safety, or personal rights of children in care. LPA observed when reviewing records at 10:00 AM there were no additional records available.	8 9 10 11 12 13 14	Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
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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: Ann Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020

LIC809 (FAS) - (06/04)

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