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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070215110
Report Date: 06/08/2023
Date Signed: 07/19/2023 03:19:38 PM


Document Has Been Signed on 07/19/2023 03:19 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:AYERS DAY CARE CENTERFACILITY NUMBER:
070215110
ADMINISTRATOR:RAPO, CANDICEFACILITY TYPE:
840
ADDRESS:5120 MYRTLE DRIVETELEPHONE:
(925) 671-4922
CITY:CONCORDSTATE: CAZIP CODE:
94521
CAPACITY:130CENSUS: 32DATE:
06/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH: Sadiyyah SabirTIME COMPLETED:
05:25 PM
NARRATIVE
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On June 8, 2023, Licensing Program Analyst (LPA) Simerjit Kaur conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION for School Age component and met with site director Sadiyyah Sabir. The facility was toured to conduct a Health and Safety Inspection. There were 5 staff members and 32 children present during the inspection. The facility is within ratio and capacity compliance today. The facility operates Monday - Friday from 7:00am - 6:00pm.

This component operates out of 3 classrooms. There are adequate play and learning materials available. Furniture and equipment is age appropriate and in good repair. There is adequate heating, ventilation and lighting. There is individual storage space for each child. All storage areas and cabinets for poisons are locked. There are fire extinguishers and working carbon monoxide detectors in classroom 1. CR Fireline Inc tested pull down alarm devices on 3/24/23.

There are separate bathrooms for staff and the children. The bathrooms for children are located in Room 1. Adequate lighting is provided in all bathrooms. All required postings are posted. The facility serves AM/PM snacks. The menu is also posted for review. Drinking water is available inside and outside.

There are age appropriate play equipment, and materials for the school age children. The first aid kit (backpack) is available in the classroom. There are electronic sign-in and sign-out logs. LPA reviewed staff file and children files. All opener and closer of facility have current CPR and First Aid certificates. All required forms were posted in a public accessible area. There are no bodies of water accessible to children. Per director there are no firearms on the premises. A copy of the children’s roster and facility roster was obtained.


See LIC 809 C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 292-7241
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: AYERS DAY CARE CENTER
FACILITY NUMBER: 070215110
VISIT DATE: 06/08/2023
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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.

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 Center 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.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.



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.

See 809D. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 292-7241
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 4
Document Has Been Signed on 07/19/2023 03:19 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: AYERS DAY CARE CENTER
FACILITY NUMBER: 070215110

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above,] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2023
Plan of Correction
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Facility director shall sumbit proof of TB (tuberculosis) test.
Type B
Section Cited
CCR
101227(a)(19)
Food Service
(a) In child care centers providing meals to children, the following shall apply: (19) All food shall be protected against contamination. Contaminated food shall be discarded immediately.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care. There were multiple boxes of snacks like powder donuts boxes, Little bites, Cheetos bites, and bread had expired.
POC Due Date: 06/14/2023
Plan of Correction
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Facility director shall submit plan of action for discarding expired food in timely manner.
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: Jason JangTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Simerjit KaurTELEPHONE: (510) 292-7241
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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