070212388-6-8-2023-02-CC-LDBX-CSLP5W-20230608110125

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070212388
Report Date: 06/08/2023
Date Signed: 06/08/2023 11:01:33 AM

Document Has Been Signed on 06/08/2023 11:01 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 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: 4	DATE:	06/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Barbara Giberti		TIME COMPLETED:	11:20 AM

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On June 08, 2023 at approximately 08:15 AM., Licensing Program Analysts (LPAs) Lorraine Dacanay Breaux and Jaleesa Jackson conducted an unannounced Annual Required Inspection and met with Director Barbara Giberti. LPA disclosed the purpose of the inspection and was granted entry into the facility by the DIrector. There were 4 preschool children present during this inspection. The facility was toured for a health and safety inspection. The hours of operation are 7:00 AM-6:00 PM, Monday - Friday.

CLASSROOMS: On Limit areas which are accessible to children include: Classroom, Practical Life, Art, Rear room (napping), Coat storage (front of the home), child's restroom and back yard play areas.

Off Limit areas which are not accessible to children include: Office, Kitchen, Staff restroom, Teacher work room (right of the entry door).

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. Parents use a daily sign in sheet to sign in their children. The floors, furniture, and equipment are age appropriate. There is adequate heating/air conditioning, ventilation, and lighting. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is in the director office and/or near the front door. The center has a wired smoke detector, a carbon monoxide detector, working telephone, fire alarm system, and (3) fully charged 2A10BC fire extinguishers.

BATHROOMS AND TOILETING AREAS: The staff's bathroom is separate from the children's bathroom. All sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets. Supplies are available to the children.

See 809-C

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WHITE DOVE SCHOOL	FACILITY NUMBER: 070212388
	VISIT DATE: 06/08/2023

NARRATIVE

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FOOD SERVICE AREAS: There is a staff kitchen area. This facility provides both meals and snacks for the children. There is a weekly menu posted at the facility. LPA observed an area where they have a refrigerator this area is free of evidence of rodents. Director was reminded to remove any expired foods as needed.

OUTDOOR PLAY AREAS: The facility has a playground area in the rear yard that is fully fenced. The slide is anchored with cushioning to absorb children's falls. There is a swing set that is anchored. All outdoor play structures are anchored and in good condition. There is a canopy and trees for shade.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Children's files and all staff files were reviewed. All staff files have required Health Screening and Employee Rights. All children's files contained Identification & Emergency, Personal Rights, and Medical Consent forms. LPA reviewed the facility roster and obtained a copy. The Director CPR & First Aid Certificate expires on 12/2023. Mandated Reporter Training was discussed. The center is following the sign in and out procedure. Disaster drills are being conducted at least once every 6 months at the last one conducted was on 05/16/23. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: The center is equipped with a fully stocked first aid kit that is available in each classroom.

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

See 809-C.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WHITE DOVE SCHOOL	FACILITY NUMBER: 070212388
	VISIT DATE: 06/08/2023

NARRATIVE

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Facility representative 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/process.

Lead Inspection has not been completed by required date of January 1, 2023. A notice of site visit was given and must remain posted for 30 days. Appeal Rights. Exit interview conducted and report was reviewed with the facility representative, Barbara Giberti

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

Document Has Been Signed on 06/08/2023 11:01 AM - 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: WHITE DOVE SCHOOL	FACILITY NUMBER: 070212388
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC809 (FAS) - (06/04)

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