073403896-9-23-2019-02-CC-RHOE-BGANEK-20190923102405

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073403896
Report Date: 09/23/2019
Date Signed: 09/23/2019 10:24:23 AM

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:	MICHAEL LANE PRESCHOOL		FACILITY NUMBER:	073403896
ADMINISTRATOR:	OLSON, KIM		FACILITY TYPE:	850
ADDRESS:	682 MICHAEL LANE		TELEPHONE:	(925) 284-7244
CITY:	LAFAYETTE	STATE: CA	ZIP CODE:	94549
CAPACITY:	17	CENSUS: 15	DATE:	09/23/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Peggy Matson		TIME COMPLETED:	10:45 AM

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	3 LPA's, Hollie and Woods met with Assistant Director, Peggy Matson for the purpose of a Random Health and Safety Inspection. Present during this visit are three staff, Ms. Matson, Ms. Miller and Ms. McDonald. There are 15 children in care. A tour of the facility was conducted. There are no bodies of water or fire arms on the premises, per the Director. During this visit, all children were under visual supervision of staff. The facility is within ratio with one teacher supervising no more than 12 children. Disinfectants, cleaning solutions, poisons and other dangerous items are inaccessible to children during this visit. Poisons are locked. All toilets and sinks are operable and sanitary with sufficient soap and paper products. Floors are free of tripping hazards. Furniture and equipment are age appropriate and appear to be in good condition and free from sharp, loose or pointed parts. The kitchen/food preparation area is free of litter, rubbish and the evidence of rodents or vermin. Food is protected from contamination and per staff, contaminated food is discarded immediately. Solid waste storage vessels (garbage cans) including moveable bins, have tight-fitting covers on and are in good repair. Uncontaminated drinking water is available both indoors and outdoors. All foods/beverages that are capable of rapid spoiling are properly stored. Snack menus are posted. The facility has a carbon monoxide detector that meets statutory requirements. All required forms are posted. PLEASE SEE NEXT PAGE FOR CONTINUED REPORT

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda Hollie	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

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: MICHAEL LANE PRESCHOOL	FACILITY NUMBER: 073403896
	VISIT DATE: 09/23/2019

NARRATIVE

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LPA encouraged the Licensee to review our website at the above address at CCLD.CA.GOV to stay up to date and informed on Laws and Title 22 Regulations as it relates to Child Care Centers, particularly the Provider Information Notices, known as PINS.

LPA informed Licensee regarding the new Law requiring Child Care Centers and Family Day care Homes to obtain Mandated Child Abuse Reporting Training, (Assembly Bill 1207). LPA informed Director that training must be completed by all staff no later than March 30 2018 and verification must be kept on file and renewed every two years. The training is free of charge and can be taken online at http://www.madaterreporterca.com/. Staff has completed this training.

THE LICENSEE WAS PROVIDED A COPY OF THEIR APPEAL RIGHTS (LIC 9058 12/15) AND THEIR SIGNATURE ON THIS FORM ACKNOWLEDGES RECEIPT OF THESE RIGHTS.

LPA POSTED THE REQUIRED POSTINGS FOR PUBLIC VIEWING.

As a result of this visit, there are no Deficiencies cited today.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda Hollie	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

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: MICHAEL LANE PRESCHOOL	FACILITY NUMBER: 073403896
	VISIT DATE: 09/23/2019

NARRATIVE

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The outdoor activity space surface is maintained in a safe condition and is free of hazards today. Playground equipment appears to be in good condition, free of sharp, loose or pointed parts. Areas around high climbing equipment, swings and slides have cushioning material(sand) to absorb falls. The facility remains fenced.

The facility is operating within its licensed capacity. The opening and closing staff have current CPR/First Aid which expires 12/19.. LPA reviewed a sampling of children’s records for admission accuracy and one staff record for qualification purposes. The sign in and sign out was reviewed for legal signatures and accuracy,

The Licensee was informed that all person’s 18 years of age or older, who are employed at the facility, must obtain a fingerprint clearance or a fingerprint cleared association, PRIOR to being in the presence of children.

THE LICENSEE WAS INFORMED THAT IF THE FACILITY RECEIVES A DEFICIENCY, THE PLAN OF CORRECTION MUST BE CORRECTED BY THE DATE PROVIDED OR A CIVIL PENALTY OF $100 PER DAY WILL BE ASSESSED TO THE FACILITY UNTIL THE DEFICIENCY IS CORRECTED. ADDITIONALLY, A REPEAT VIOLATION OF A DEFICIENCY WILL BE ASSESSED IN THE AMOUNT OF $250 AND $100 PER DAY UNTIL CORRECTED.

LPA discussed the Incidental Medical Services for students who require medication, and there are none this school year.

LPA DISCUSSED WITH LICENSEE THAT AS OF SEPTEMBER 1, 2016, ANY PERSON(S) EMPLOYED OR VOLUNTEERING AT A CHILD CARE CENTER SHALL BE IMMUNIZED AGAINST INFLUENZA(optional), PERTUSSIS AND MEASLES OR MUST QUALIFY FOR AN EXEMPTION, Staff have provided immunization's. PLEASE SEE NEXT PAGE FOR CONTINUED REPORT.

SUPERVISOR'S NAME: Anika Evans	TELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda Hollie	TELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019

LIC809 (FAS) - (06/04)

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