070206625-3-12-2020-02-CC-CACA-BMMPBN-20200312111037

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070206625
Report Date: 03/12/2020
Date Signed: 03/12/2020 11:10:45 AM

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:	CLAYTON VALLEY PRESBYTERIAN CHILDREN'S CENTER		FACILITY NUMBER:	070206625
ADMINISTRATOR:	MILLER, MICHELLE		FACILITY TYPE:	850
ADDRESS:	1578 KIRKER PASS ROAD		TELEPHONE:	(925) 672-0882
CITY:	CLAYTON	STATE: CA	ZIP CODE:	94517
CAPACITY:	63	CENSUS: 36	DATE:	03/12/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Michelle Miller		TIME COMPLETED:	11:30 AM

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 Analysts (LPAs) Cherie Acosta and Jaylena Miller conducted an unannounced Annual Required inspection. There were 9 staff and 36 children present during the inspection. Furniture and equipment was observed to be in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the visit. The toilets and sinks were in operable condition. The floors were free of tripping hazards. The kitchen/food preparation and storage areas were observed to be clean and free of evidence of rodents. Food is protected against contamination. All storage containers for solid waste have tight-fitting covers that are in good repair. Drinking water is available both indoors and outdoors. Menus are posted and visible for parents to review. There are no pools or similar bodies of water at this facility. Outdoor activity space and playground equipment was observed to be safe and free of hazards. The facility is operating within its licensed capacity. The facility is within ratio today with one teacher supervising no more than 12 children. LPA did not observe any child left without visual supervision or unattended during the inspection. LPA verified both opening and closing staff have current CPR/First aid training. A physical census was taken of all children present and crossed referenced with the sign in and out sheets. The director understands that prior to working or volunteering in a licensed child care facility, all individuals subject to criminal record review shall obtain a clearance or criminal record exemption. A sample of children’s records were reviewed. Files reviewed contained emergency information and health assessments. Staff records reviewed have required health screening, immunizations and current mandated reporter training. Fire/Disaster drill are conducted monthly.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

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: CLAYTON VALLEY PRESBYTERIAN CHILDREN'S CENTER	FACILITY NUMBER: 070206625
	VISIT DATE: 03/12/2020

NARRATIVE

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Individual Medical Services (IMS) was discussed. The following information regarding ADA was provided to licensee… US DOJ toll free ADA Information Line (800) 514-0301 and the link to FAQ about child care and ADA http://www.ada.gov/childqanda.htm
LPA discussed the need to update the centers plan of operation to reflect IMS plan when needed.

The director was encouraged to email ChildCareAdvocatesProgram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

Child Care providers are required 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 director that all forms can be downloaded at www.ccld.ca.gov

There were no deficiencies cited during today’s inspection.

An exit interview was conducted with Michelle Miller. The director was provided a copy of her appeal rights and the signature on this form acknowledges receipt of these rights. A Notice of Site visit was provided at the time of inspection and must be posted for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Cherie Acosta	TELEPHONE: (510) 622-1623
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020

LIC809 (FAS) - (06/04)

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