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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423097
Report Date: 06/29/2022
Date Signed: 06/29/2022 12:46:56 PM

Document Has Been Signed on 06/29/2022 12:46 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:GOLDEN BAY PRESCHOOLFACILITY NUMBER:
013423097
ADMINISTRATOR:MA, YANYIFACILITY TYPE:
830
ADDRESS:2226 PACIFIC AVENUETELEPHONE:
(510) 213-9832
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: 0DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Yanyi MaTIME COMPLETED:
12:00 PM
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On 06/29/2022 Licensing Program Analyst (LPA), Arminder Singh conducted an unannounced annual/random inspection at facility. LPA met with Director, Yanyi Ma and explained the purpose of today’s inspection. Hours of operation are Monday- Friday 8:00AM-5:30PM. There is an active waiver on file for shared use of bathroom for the infant, toddler, and preschool components at different times, based on schedule submitted, to ensure they will not commingle.

During today's visit there were no children present due to the facility having difficulty obtaining staffing. Facility plans to operate in the future given they have enough staffing. LPA toured the Facility both inside and outside during today's inspection. 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), and Activity Schedule.

Director has current mandated reporter training and current CPR and First Aid certifications on file. Facility 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).

Facility understands the conditions, limitations, and capacity specifications of the Facility license. Facility understands that children shall be visually supervised at all times.

Continued on 809-C
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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: GOLDEN BAY PRESCHOOL
FACILITY NUMBER: 013423097
VISIT DATE: 06/29/2022
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The Facility is aware of the required sign in and sign out procedures. Children should be picked up by their respective parent(s)/guardian(s) and no child is allowed to go home on his/her own.

LPA observed that the classroom is clean and safe for all children and staff. Drinking water is readily available for the children in the outdoor playground area. LPA observed solid waste containers with tight-fitting lids where food is served. Staff and children's bathrooms are clean, sanitary, and operable. Staff bathroom can be used as an isolation bathroom if needed. Facility does not have any weapons or firearms on the premises.

The facility does have snacks available for the children. Children bring their own lunch from home when facility is operating. Cleaning supplies are inaccessible to the children and stored in locked cabinets. Any poisons are stored in the locked storage cabinet.

LPA observed all furniture and equipment is in good condition and safe for the children.

Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe . The play equipment was maintained in good condition and free of hazards. There were no bodies of water observed. The outdoor playground area has a shaded area for the children. The outdoor playground area is also utilized for lunch time to serve food.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
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: GOLDEN BAY PRESCHOOL
FACILITY NUMBER: 013423097
VISIT DATE: 06/29/2022
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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.

LPA discussed the safe sleep regulations with Director 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 Director 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.

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.

No deficiencies cited during today’s visit

Exit Interview was conducted, where this report was discussed with Director.



Report was signed confirming receipt of documents.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC809 (FAS) - (06/04)
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