073402749-5-27-2022-02-CC-CCON-CETRZJ-20220527132800

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073402749
Report Date: 05/27/2022
Date Signed: 05/27/2022 01:28:11 PM

Document Has Been Signed on 05/27/2022 01:28 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 - CHAVEZ SCHOOL		FACILITY NUMBER:	073402749
ADMINISTRATOR:	MARKER, ALISON		FACILITY TYPE:	850
ADDRESS:	960 - 17TH STREET		TELEPHONE:	(510) 231-1418
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94801
CAPACITY:	24	CENSUS: 13	DATE:	05/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:23 AM
MET WITH:	Nora Iragorri		TIME COMPLETED:	01:42 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 Friday. May 27, 2022 at 10:23 AM, Licensing Program Analyst (LPA) Caroline Colson, arrived at the facility and met with Nora Iragorri, Lead Teacher, to conduct an annual required inspection. Olanrewaju Ajayi, Early Learning Program Preschool Coordinator arrived during the inspection. A Health and Safety Inspection was conducted. LPA made the following observations: Capacity/Staffing: There are 13 preschool children present with 3 teachers in one classroom. Physical Plant: The facility consist of one (1) classroom in two (2) story school building. There is one (1) bathroom. 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 don't take naps at facility. The facility provides breakfast, lunch and snacks. 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, slides are safe and in good condition. Playground is free of debris and other hazards. Drinking water readily available. There are no pools, hot tubs or other bodies of water present. Please 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: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

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: WCCUSD - CHAVEZ SCHOOL	FACILITY NUMBER: 073402749
	VISIT DATE: 05/27/2022

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 extinguishers was serviced in November 2021. Pediatric CPR and First Aid Certificates are current and expire on October 13, 2023. First 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 signatures 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. Director has 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.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

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: WCCUSD - CHAVEZ SCHOOL	FACILITY NUMBER: 073402749
	VISIT DATE: 05/27/2022

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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.

Licensee will need to purchase or create a shaded area for the children in the outdoor play space.

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, Olanrewaju Ajayi.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC809 (FAS) - (06/04)

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