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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070212743
Report Date: 12/08/2023
Date Signed: 12/08/2023 04:01:28 PM


Document Has Been Signed on 12/08/2023 04:01 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:WCCUSD - DOVERFACILITY NUMBER:
070212743
ADMINISTRATOR:ATTIG, ZEENAFACILITY TYPE:
850
ADDRESS:1871 21ST STREETTELEPHONE:
(510) 231-1420
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY:24CENSUS: 13DATE:
12/08/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Zeena AttigTIME COMPLETED:
04:00 PM
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On 12/08/2023 at 1:30 pm Licensing Program Analysts (LPA) Christina Watts conducted an unannounced 3 Year Inspection at WCCUSD - Dover. The facility is on the ground of Dover Elementary School. LPA met with Director, Zeena Attig and explained the purpose of today's inspection. During inspection, there were 13 preschool aged children in care with 3 staff in 1 classroom. Director stated there are 38 children enrolled. All staff caring and supervising children have Criminal Record Clearance per WCCUSD. Facility is a part day program with an AM program and a PM program. Facility's operating days and hours are Monday to Friday from 8:15 AM - 3:15 PM in 1 Room. .

The physical plant was inspected. LPA toured the premises with the Director.
Indoor space: 1 classroom, and restrooms. During inspection, children were engaged in various activities under the visual supervision of the teacher and aide. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. 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. Elementary school provides lunch for daycare children. Trash cans for solid waste had tight-fitting covers on and were in good repair. LPA observed a working Fire extinguisher, Smoke and Carbon Monoxide Detectors. Log shows that the last Fire Drill was conducted on November 2023. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles. Facility’s License, Parents’ Rights Poster PUB 393, Personal Rights, Activity Schedules, and Menus were observed to be posted.

File Review: Children sign in and out procedures and logs were reviewed. A sampling of Children and Staff files was taken for review. All files contained required documents. There was at least one Teacher with current certification in Pediatric CPR/First Aid present at the facility during inspection. Children's Roster and Personnel Report was reviewed, and a copy obtained. *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: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2023
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: WCCUSD - DOVER
FACILITY NUMBER: 070212743
VISIT DATE: 12/08/2023
NARRATIVE
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*PAGE 2*

Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe. LPA observed playground areas for children with age appropriate toys and play structures. The play equipment was maintained in good condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. Shade is provided by way of covered areas. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.

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. Review of staff files show that staff has completed Mandated Reporter training.



Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP) LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

*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: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
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: WCCUSD - DOVER
FACILITY NUMBER: 070212743
VISIT DATE: 12/08/2023
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*PAGE 3*

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

LPA Christina Watts informed Director Zeena Attig that this report dated 12/08/2023 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.

*SEE LIC 809-D FOR DEFICIENCIES*

Exit interview conducted and report was reviewed with the Director, Zeena Attig. A 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: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 12/08/2023 04:01 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: WCCUSD - DOVER
FACILITY NUMBER: 070212743

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2023

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
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Based on interview, the licensee did not comply with the section cited above when facility has not tested water for lead contamination which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/08/2024
Plan of Correction
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Facility is required to test for lead contamination.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4