<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070211217
Report Date: 04/12/2023
Date Signed: 04/12/2023 03:22:51 PM


Document Has Been Signed on 04/12/2023 03:22 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:WALNUT ACRES DAY CARE CENTERFACILITY NUMBER:
070211217
ADMINISTRATOR:GONCE, JAIMEFACILITY TYPE:
840
ADDRESS:450 WIGET LANETELEPHONE:
(925) 932-0507
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:170CENSUS: 137DATE:
04/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jaime TeelTIME COMPLETED:
03:45 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 04/12/2023 at 12:30 PM, Licensing Program Analysts (LPAs) Christina Watts and Monica Mathur conducted an unannounced Annual inspection of Walnut Acres Day Care Center - School Age Program which is located in the premises of Walnut Acres Elementary School. LPA met with Director, Jamie Teel and explained the purpose of today's inspection. During today's inspection, there were 137 school age children in care with 15 staff. Facility's operating days and hours are Monday to Friday from 7:00 AM - 6:00 PM in 1 portable building.

The physical plant was inspected. LPA toured the premises with the Director.
Indoor space: The classroom, restrooms, food storage areas and spaces accessible to children were inspected. Disinfectants, cleaning solutions, poisons and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Storage areas for poisons were locked and medications were kept in a safe place inaccessible to children. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Foods and beverages were stored safely. Food storage area were clean, free of litter, or rubbish. Trash cans for solid waste had tight-fitting covers on and were in good repair. Director stated that facility does not possess nor store any weapons on the premises. LPA observed a working Fire extinguisher, Smoke and Carbon Monoxide Detectors, and fire pull stations. All toilets, hand washing areas were observed to be in safe and sanitary operating condition. All materials and surfaces accessible to children appeared to be toxic free. Facility was observed to be in compliance with school age regulation requirements during LPAs' inspection. LPA observed a turtle, fish and bearded dragon in the facility.
CON'T ON PAGE 2*
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


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: WALNUT ACRES DAY CARE CENTER
FACILITY NUMBER: 070211217
VISIT DATE: 04/12/2023
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
26
27
28
29
30
31
32
*PAGE 2*

Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe. Through the gates is a large outdoor area with basketball courts, panels for shade, and play structure with garden areas. The play equipment was maintained in good condition and free of hazards. Surface of the outdoor activity space was in safe condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.

Facility conducted Lead Testing and submitted documentation to licensing. Director was reminded that Lead Testing must be completed every 5 years.

File Review: Children sign in and out procedures and logs were reviewed. Facility uses Cura Cubby application for sign in/sign out for parents/authorized representatives. All children were signed in and in compliance with the school age sign in/out procedures. A sample of Children and Staff files was taken for review. All files contained required documents. There was at least one staff with current certification in Pediatric CPR and First Aid at the facility during inspection. Children's Roster LIC 9040 and Personnel Report LIC 500 was reviewed, and a copy obtained. Log shows last Fire Drill was conducted in March 13, 2023.



During record review, it was discovered 1 staff member did not have criminal record clearance. LPA informed Director of clearance status for Jennifer Louie and Director was unaware that staff has been disassociated. Director stated that she did not disassociate staff from facility and not sure who disassociated staff from facility. Director understands that staff cannot care or supervise children in the facility without a criminal record clearance. Director and all other staff have Criminal Record Clearance. 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.

CON'T ON PAGE 3*
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: WALNUT ACRES DAY CARE CENTER
FACILITY NUMBER: 070211217
VISIT DATE: 04/12/2023
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
26
27
28
29
30
31
32
*PAGE 3*

This facility provides 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 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

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.

LPA Christina Watts informed Jamie Teel that this report dated 04/12/2023 documents a Type B citation. Type B citation(s) are a potential risk(s) to the health, safety, or personal rights of children in care. A civil penalty of $100 has been assessed today.

See LIC 809D for deficiency.


Exit interview conducted and report was reviewed with the Director, Jamie Teel. Notice of Site Visit was given and must remain posted for 30 consecutive days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/12/2023 03:22 PM - It Cannot Be Edited

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: WALNUT ACRES DAY CARE CENTER
FACILITY NUMBER: 070211217

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type B
Section Cited
CCR
101170(e)(1)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the facility did not comply with the section cited above when staff Jennifer Louie, did not obtain a criminal record clearance and was caring for children which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/19/2023
Plan of Correction
1
2
3
4
Staff will obtain a criminal record clearance and Director will submit proof of clearance.*Note* Staff left during inpection to get live scan.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4