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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070209834
Report Date: 05/29/2019
Date Signed: 05/29/2019 03:29:31 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:NOMURA SCHOOL (THE)FACILITY NUMBER:
070209834
ADMINISTRATOR:WAITHERA LUCY KARUNJAFACILITY TYPE:
850
ADDRESS:1711 CARLSON BOULEVARDTELEPHONE:
(510) 526-7847
CITY:RICHMONDSTATE: CAZIP CODE:
94804
CAPACITY:125CENSUS: 108DATE:
05/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Keiko HernandezTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Paul Petersen conducted an unannounced random annual site inspection for this facility on 05/29/19 at 1120. LPA met with acting facility director, Keiko Hernandez, and toured all areas of the facility utilized by children in care. Also present at the time of this inspection were 108 preschool age children in care and 11 additional teaching staff. All staff present are background cleared and qualified teachers. The facility is within ratio and capacity. Per acting director, there are no firearms on site at this facility. This facility operates out of three separate buildings located adjacent to each other. The Main Building consists of the Puffin, Rooster, and Crane classrooms and the adjacent separate buildings consist of the Chicky and Penguin classrooms. All five classrooms were inspected for a health and safety inspection. Per facility director, the facility receives janitorial service daily. Counter tops, floors and other surfaces are free of toxins or other hazardous items. Furnishings and equipment are age appropriate and free of observed sharp/broken pieces. Children have individual storage cubbies for their personal belongings in all classrooms. Children have their own individual sippy cups for drinking water and there are water fountains present in the classrooms and outdoors on the play area. There are sleeping mats for children napping and each child's linens are stored separately and washed at least weekly. The facility has centralized smoke detectors/fire alarm system as well as working carbon monoxide detectors. Per acting director, the most recent fire department inspection for this facility was July 2018. Each classroom has bathrooms for children including age appropriate toilets and sinks/faucets in working condition. The facility has heating and ventilation available for temperature management. Children bring their lunch from home and the facility serves snacks for children. A snack menu is posted an available for review. All required postings are present including one waiver for electronic sign in, sign out. At approximately 1:00 PM, LPA observed while reviewing the electronic sign in, sing out records that one child was present in the Chicky classroom that was not signed in and two children were present in the Penguin classroom that were not signed in. The outdoor play areas are fully fenced with a variety of age appropriate play equipment present. The high climbing equipment/slides used by the older children are securely anchored and free of broken or sharp pieces. The high climbing equipment has appropriate cushioning under and around the equipment. Facility staff is reminded to inspect/manage all outdoor wood furnishings to ensure absence of splintering/hazards. There are no pools, hot tubs or other accessible bodies of water present. LPA reviewed the facility, personnel and
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SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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: NOMURA SCHOOL (THE)
FACILITY NUMBER: 070209834
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2019
Section Cited
CCR
101229.1(b)
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101229.1(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out. This facility was not in compliance with this requirement as evidenced by LPA's observation that a total of three children were present today in the Chicki and Penguin classrooms who were not signed in on the electronic sign in, sign out recors posing
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This facility agrees to ensure that going forward all children in care will be signed in and signed out as required. In addition the faciltiy will submit to licensing by the POC date, a written plan/steps to be implemented to ensure that all chidlren are singed in/out. Failure to correct will result in a $100 per day civil penalty until
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a potential risk to the health and safety of children in care.
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corrected. Repeat violations are $250 per violation and $100 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: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
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: NOMURA SCHOOL (THE)
FACILITY NUMBER: 070209834
VISIT DATE: 05/29/2019
NARRATIVE
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children's records including staff background clearances, qualifications and immunization records and children's admissions agreements, parent's rights forms and immunization records. Teacher qualification forms were completed for five staff during this inspection. Multiple staff present are CPR/First Aid certified. This facility provide Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information 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 For forms and updates visit www.ccld.ca.gov.

The attached Type B deficiency is cited during this inspection. An exit interview was conducted with the acting director. Appeal Rights were issued and Notice of Site Visit was issued and posted. This notice is to be posted for 30 consecutive days. A copy of this report shall be maintained for 3 years and available for public review upon request.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul PetersonTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3