070212388-5-10-2019-02-CC-GRED-BC2Q3Q-20190510114907

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070212388
Report Date: 05/10/2019
Date Signed: 05/10/2019 11:49:16 AM

COMPREHENSIVE INSPECTION

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:	WHITE DOVE SCHOOL		FACILITY NUMBER:	070212388
ADMINISTRATOR:	GIBERTI, BARBARA		FACILITY TYPE:	850
ADDRESS:	1850 SECOND STREET		TELEPHONE:	(925) 689-5067
CITY:	CONCORD	STATE: CA	ZIP CODE:	94519
CAPACITY:	41	CENSUS: 10	DATE:	05/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:56 AM
MET WITH:	Barbara Giberti, Licensee		TIME COMPLETED:	12:00 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	Licensing Program Analyst (LPA) Redmond, arrived at the facility on 05/10/2019 at 10:56 AM, to conduct a health and safety inspection. The purpose of the inspection is to ensure the facility is in compliance with Title 22, CCR and Health and Safety Code Statutes for Child Care Centers. During the inspection, LPA met with Barbara Ghiberti, Director. Ms. Giberti accompanied LPA during the inspection. During the inspection, LPA made the following observations: Capacity/Staffing: On this date there are ten (10) children in care. The children range in age from 2 – 5 years old (school aged). There are currently three (3) teachers present, including the Licensee. The facility is in compliance with capacity limitations, child ratios and staffing levels. LPA inspected all areas of the facility accessible to children. On Limit areas which are accessible to children include: Classroom, Practical Life, Art, Coat storage, restroom and back yard play areas. Off Limit areas which are not accessible to children include: Office, Kitchen, Staff restroom, Teacher work room. At the entrance to the facility are the required postings: Facility License, Emergency Disaster Plan, Notification of Parent's Rights, Earthquake Preparedness Checklist. If You See Something, Say Something was added on this date. Parents use a daily sign in sheet to sign in their children. Classroom: Furniture and equipment age appropriate and in good repair. Adequate heating, lighting and ventilation. CONTINUED

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

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: WHITE DOVE SCHOOL	FACILITY NUMBER: 070212388
	VISIT DATE: 05/10/2019

NARRATIVE

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There is separate storage for children’s belongings. There are cots available to each child. Children’s cots are cleaned every week. Parents launder the children’s bedding each week. The day care prepares a food, a menu is posted.

Restroom: Toilets and sinks are operable. There is soap, toilet paper and paper towels for sanitary use. There are no cleaning solutions or toxins accessible to children.

Play yard: Enclosed with yard. Climbing structures, swings, slides and other large play equipment, which, is securely anchored and free from hazards. There is a shaded area. Playground is free of debris and other hazards. Drinking water readily available. No pools or other bodies of water present.

Emergency Preparedness/Safety: Smoke detectors are located throughout the facility and is inspected and tested by a professional company, as well as the fire extinguisher. Fire extinguisher inspection tag was dated 07/23/2018 and is classified as 3 A 40 B C which meets fire marshal requirements. Carbon monoxide detector was tested by LPA and found to be operable. First aid supplies available. Emergency Disaster Plan is dated 3/20/2018 and is current, per the Director. Fire and earthquake drills were last conducted on 03/13/2019 and meet six (6) month requirement. The facility utilizes a land line and a cellular telephone. The facility is not currently providing *Incidental Medical Services (IMS) however, is aware of IMS requirements.

Training/Record Review:
Director has current CPR/First Aid training, which expires on 10/19 Staff persons on duty have current CPR/First Aid which expire same date. Director and staff have completed Mandated Reporter training, with certifications on file.

Exit interview conducted. This Facility Evaluation Report discussed with the Licensee and signature obtained below. Notice of site visit was issued and shall be posted remain posted for 30 days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty. A copy of this report shall be maintained for 3 years and available for public review upon request.

FACILITY IN SUBSTANTIAL COMPLIANCE. NO DEFICIENCIES CITED ON THIS DATE.

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019

LIC809 (FAS) - (06/04)

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