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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403772
Report Date: 03/28/2023
Date Signed: 03/28/2023 04:27:45 PM


Document Has Been Signed on 03/28/2023 04:27 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:CAMBRIDGE COMMUNITY CENTERFACILITY NUMBER:
073403772
ADMINISTRATOR:KANWAL LACHHARFACILITY TYPE:
850
ADDRESS:1146 LACEY LANETELEPHONE:
(925) 798-1078
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY:93CENSUS: 47DATE:
03/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:KANWAL LACHHARTIME COMPLETED:
04:30 PM
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8:15AM- LICENSING PROGRAM ANALYST TASHA ALEXANDER MET TODAY WITH CENTER DIRECTOR KANWAL LACHHAR AND SITE SUPERVISOR KERRYN MAGALUED FOR AN UNANNOUNCED 1 YEAR/REQUIRED INSPECTION. TODAY THERE ARE 47 PRESCHOOL AGE/INFANT TODDLER CHILDREN PRESENT ALONG WITH 11 STAFF MEMBERS. THE FACILITY HAS AGE APPROPRIATE FURNITURE AND NAPPING EQUIPMENT WHICH APPEARS TO BE IN GOOD REPAIR. THE INDOOR AND OUTDOOR ACTIVITY SPACES APPEARED TO BE IN GOOD REPAIR. DISINFECTANTS, CLEANING SOLUTIONS, POISONS AND OTHER ITEMS THAT ARE DANGEROUS TO CHILDREN WERE INACCESSIBLE DURING TODAY'S INSPECTION. THE SINKS WERE OBSERVED TO BE IN OPERABLE CONDITION. THE FLOORS ARE FREE OF TRIPPING HAZARDS. BREAKFAST,BREAKFAST, LUNCH AND SNACKS ARE PROVIDED BY THE FACILITY. THE KITCHEN WAS OBSERVED TO BE CLEAN AND FREE OF EVIDENCE OF RODENTS. FOOD/SNACKS ARE PROTECTED AGAINST CONTAMINATION. ALL STORAGE CONTAINERS FOR SOLID WASTE HAVE TIGHT FITTING LIDS THAT ARE IN GOOD REPAIR. DRINKING WATER IS AVAILABLE BOTH INDOORS AND OUTDOORS. MENUS ARE POSTED AND VISIBLE FOR PARENTS TO REVIEW. OUTDOOR ACTIVITY SPACE AND PLAYGROUND EQUIPMENT WAS OBSERVED TO BE SAFE AND FREE OF HAZARDS WITH APPROPRIATE MATERIAL TO ABSORB FALLS. THERE ARE CANOPIES ON THE PLAYGROUNDS TO PROVIDE SHADED AREAS FOR CHILDREN.

THE FACILITY IS OPERATING WITHIN IT'S LICENSED CAPACITY. THE FACILITY IS WITHIN RATIO TODAY. LPA DID NOT OBSERVE ANY CHILD LEFT WITHOUT SUPERVISION DURING INSPECTION. LPA VERIFIED THAT AT LEAST ONE STAFF HAS CURRENT CPR/1ST AID TRAINING. A PHYSICAL CENSUS WAS TAKEN OF ALL CHILDREN PRESENT AND CROSSED REFERENCED WITH THE SIGN/OUT SHEETS.

THE LICENSEE UNDERSTANDS THAT PRIOR TO WORKING OR VOLUNTEERING IN A LICENSED CHILD CARE FACILITY, ALL INDIVIDUALS SUBJECT TO CRIMINAL RECORD REVIEW SHALL OBTAIN A CLEARANCE OR CRIMINAL RECORD EXEMPTION
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
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: CAMBRIDGE COMMUNITY CENTER
FACILITY NUMBER: 073403772
VISIT DATE: 03/28/2023
NARRATIVE
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A SAMPLE OF CHILDREN'S RECORDS WERE REVIEWED. FILES REVIEWED CONTAINED EMERGENCY INFORMATION AND CURRENT IMMUNIZATION RECORDS. STAFF RECORDS REVIEWED. TEACHERS PRESENT TODAY MEET QUALIFICATION REQUIREMENTS.

Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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

SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
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: CAMBRIDGE COMMUNITY CENTER
FACILITY NUMBER: 073403772
VISIT DATE: 03/28/2023
NARRATIVE
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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

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.

PLEASE SEE THE ATTACHED 809-D FOR CITATION.



An exit interview was conducted. A notice of site visit was posted.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/11/2023 04:50 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/11/2023 04:45 PM

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: CAMBRIDGE COMMUNITY CENTER
FACILITY NUMBER: 073403772

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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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. This requirement is not met as evidenced by: a review of records which revealed staff members marisol moreno and Pamela Beltran do not have the required health screening report in file.
POC Due Date: 04/11/2023
Plan of Correction
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LICENEE WILL HAVE EACH STAFF MEMBER OBTAIN FROM THEIR PHYSICIAN A HEALTH SCREENING REPORT. LICENSEE WILL SUBMIT COPIES OF THE REPORTS TO COMMUNITY CARE LICENSING BY 4/11/23
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: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4