070206625-3-15-2023-02-CC-MGUT-CPXU2P-20230315151217

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070206625
Report Date: 03/15/2023
Date Signed: 03/15/2023 03:12:42 PM

Document Has Been Signed on 03/15/2023 03:12 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:	CLAYTON VALLEY PRESBYTERIAN CHILDREN'S CENTER		FACILITY NUMBER:	070206625
ADMINISTRATOR:	KRISTINE BUCHHOLZ		FACILITY TYPE:	850
ADDRESS:	1578 KIRKER PASS ROAD		TELEPHONE:	(925) 672-0882
CITY:	CLAYTON	STATE: CA	ZIP CODE:	94517
CAPACITY:	63	CENSUS: 24	DATE:	03/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:14 PM
MET WITH:	Kristine Buchholz		TIME COMPLETED:	02:30 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 3/15/2023, Licensing Program Analysts (LPAs) Melissa Guirit and Melissa Domantay made an unannounced required annual inspection at the above facility. LPAs was met by Director, Kristine Buchholz. Present for the inspection were 24 children and seven staff. The entire facility was toured to conduct a health and safety inspection. Facility operates Monday through Friday from 7:00am-6:00pm. LPAs toured the premises with Director. The preschool program operates in three buildings in three classrooms. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. There are four toilets and four sinks available for children's use. There is a separate restroom for staff. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers and were in good repair. LPAs observed multiple 3A40BC Fire extinguishers, smoke and Carbon Monoxide Detectors. The last Fire Drill was conducted on 03/14/2023. Director is reminded that fire drills should be conducted at least every 6 months. The center is equipped with a fully stocked first aid kit and working telephone. Facility does not provide transportation for preschool children, but Director understands that children cannot be left alone, unattended in parked vehicles. Facility’s License, Parents’ Rights Poster PUB 393, Personal Rights, and activity schedules were observed to be posted. Children bring their own lunch to school and facility provides morning and afternoon snack. Isolation area for sick children is in the Director's office. Outdoor playground was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards. Areas around the outdoor play yard are cushioned with material that absorbs falls. Shade is provided by way of covered areas. There were no bodies of water observed during today's inspection. Drinking water is arranged to be readily available to children during indoor and outdoor activities. Children utilize personal reusable water bottles. See 809-C for continuance.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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: 03/15/2023

NARRATIVE

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Children sign in and out procedures and logs were reviewed. Facility uses electronic sign in/sign out procedure. LPAs reminded facility to maintain sign in/sign out procedures and make sure parents/authorized representatives sign the child in and out. Four children's files and seven staff files were reviewed and contained required documents. Director, Kristine Buchholz has a valid CPR/First Aid Certificate, expires on 08/05/2024. Children's Roster and staff personnel report was reviewed. A copy of staff personnel report and children's roster were provided to LPAs by Director.

On or before March 30, 2018 any person who works in a child care facility shall complete Mandated Reporter training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

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

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/ction-process.

There are no deficiencies cited today. Exit interview conducted and report was reviewed with Director, Kristine Buchholz. A Notice of Site Visit was given and must remain posted for 30 consecutive days.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC809 (FAS) - (06/04)

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