073400419-3-20-2023-02-CC-CCON-CPZURR-20230317154911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073400419
Report Date: 03/17/2023
Date Signed: 03/20/2023 11:21:46 AM

Document Has Been Signed on 03/20/2023 11:21 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:	WCCUSD - MONTALVIN C/O PRESCHOOL DEPARTMENT		FACILITY NUMBER:	073400419
ADMINISTRATOR:	ROMERO, VENESSA		FACILITY TYPE:	850
ADDRESS:	300 CHRISTINE DRIVE		TELEPHONE:	5102311405
CITY:	SAN PABLO	STATE: CA	ZIP CODE:	94806
CAPACITY:	24	CENSUS: 17	DATE:	03/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:28 AM
MET WITH:	Derri Pollack		TIME COMPLETED:	04:03 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 Wednesday, March 17, 2023 at 10:28 AM, Licensing Program Analyst (LPA) Caroline Colson met with Derri Pollack, Acting Center Director, for an unannounced random annual inspection. Operating Hours are Mondays - Fridays from 8:15 AM to 11:15 AM and 12:00 PM to 3:00 PM. Capacity/Staffing: The facility is a preschool program with a morning and afternoon class. The facility is in a portable adjacent to the elementary playground and a Title V program. There are 17 preschool children present with 3 staff members including the acting Center Director. Physical Plant: The restrooms are in the classroom. There is adequate heating, lighting and ventilation. There are no cleaning solutions, chemicals or other hazards accessible to children. Classrooms: Furniture and equipment age appropriate and in good repair. There are separate storage areas for children’s belongings. Children do not take naps at the facility. The facility provides breakfast for the AM classroom and lunch in the PM classroom. The menu is posted for review. Restrooms: Toilets and sinks are operable. There is soap, toilet paper and paper towels for sanitary use. Play yard: Climbing structures, swings, slides are safe and in good condition. There is a shaded area. Playground is free of debris and other hazards. Children have water bottles. There are no pools, hot tubs or other bodies of water present. CONTINUED

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

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: WCCUSD - MONTALVIN C/O PRESCHOOL DEPARTMENT	FACILITY NUMBER: 073400419
	VISIT DATE: 03/17/2023

NARRATIVE

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Emergency Preparedness/Safety: Smoke detector was inspected by an outside company. Carbon monoxide detector was tested and is working. The 3A40BC fire extinguisher was serviced in August 2022. First Aid Kit is available and complete. Emergency Disaster Plan is posted. The facility utilizes a land line telephone.

Postings: Facility License, Emergency Disaster Plan, Notification of Parent's Rights, Earthquake Preparedness Checklist.

Sign in Sheet/Class Roster: All parents use an electronic signature to sign in and sign out. The roster is current and available.

Training/Record Review:
All staff present on this date have criminal background clearances and are associated to the facility. Staff have current CPR/First Aid and Mandated Reporter certificates on file. Immunization records including influenza and or a statement declining vaccination.

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

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.

Please See LIC 809 C for Additional Information

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

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: WCCUSD - MONTALVIN C/O PRESCHOOL DEPARTMENT	FACILITY NUMBER: 073400419
	VISIT DATE: 03/17/2023

NARRATIVE

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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.

As a result of this inspection, there are no deficiencies cited during today's inspection.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Facility Representative, Derri Pollack.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

LIC809 (FAS) - (06/04)

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