073405004-7-18-2019-02-CC-GRED-BE7PVD-20190718113859

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405004
Report Date: 07/18/2019
Date Signed: 07/18/2019 11:39:08 AM

COMPREHENSIVE INSPECTION

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:	TABERNACLE SCHOOL		FACILITY NUMBER:	073405004
ADMINISTRATOR:	AMY HOYE		FACILITY TYPE:	850
ADDRESS:	4380 CONCORD BLVD		TELEPHONE:	(925) 685-9169
CITY:	CONCORD	STATE: CA	ZIP CODE:	94521
CAPACITY:	48	CENSUS: 15	DATE:	07/18/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	SHREVE, REBECA, ADMINISTRATOR		TIME COMPLETED:	11:45 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	Licensing Program Analyst (LPA) Redmond, conducted an unannounced, Annual/Random health and safety inspection of the facility. During the inspection, LPA met with SHREVE, REBECA, ADMINISTRATOR. Amy Hoye is no longer the Director and has been replaced by G. Francis. However, Ms. Francis has an inactive criminal record clearance and cannot be present at the facility until corrected. The purpose of the inspection is to ensure the facility is in compliance with Title 22, CCR and Health and Safety Code regulations for licensed Child Care Centers. LPA inspected all areas of the facility accessible to children. During the inspection the LPA made the following observations: Capacity/Staffing: The facility is licensed for 48 children. On this date there fifteen (15) school aged children present and two (2) teachers present. Posted Required: Facility License, Emergency Disaster Plan, requires an update to staff, signature and date. Notification of Parent's Rights, Earthquake Preparedness Checklist. If You See Something, Say Something. Emergency disaster drills were last conducted on 05/14/19 and are on file. Classrooms: Furniture and equipment age appropriate and in good repair. The furniture and equipment are in safe condition and is free from sharp, loose or pointed parts. All hazardous materials and toxins are kept out of the reach of children Adequate heating, lighting and ventilation. There is separate storage for children’s belongings. The facility utilizes mats for child sleep. Dining: The school offers a snack for the children and the snacks are eaten in classroom. - CONTINUED LIC 809 C

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

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: TABERNACLE SCHOOL	FACILITY NUMBER: 073405004
	VISIT DATE: 07/18/2019

NARRATIVE

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Restrooms: Toilets and sinks are operable. There is soap, toilet paper and paper towels for sanitary use.

Play yard: Enclosed with gate. Climbing structures, swings, slides and other large play equipment, which, are securely anchored and free from hazards. There is a shaded area. Playground is free of debris and other hazards. Drinking water readily available. There are no pools, fish ponds or other bodies of water present.

Emergency Preparedness/Safety: Smoke detector and carbon monoxide detectors are installed and inspected by a professional company. LPA observed inspection record, which, was dated, 06/04/19. There are two (2) fire extinguishers, classified as 3 A 40 B:C, which is approved by fire marshal which were also tested. Fire and earthquake drills were last conducted in 05/14/19. First aid supplies available. The facility does not care for infants therefore Safe Sleep regulations is inapplicable. The facility utilizes a land line. The facility is currently providing *Incidental Medical Services (IMS) for children in care. Facility is not currently providing Incidental Medical Services (IMS) to any children at this time. An IMS plan must be submitted to LPA if the facility plans to offer IMS services in the future.

Training/Record Review:
LPA reviewed training records for four (4) teachers, two of which are working on this date. Each have current CPR/First Aid training. Teachers have current Mandated Reporter training on have certifications on file. All staff have health screening, current immunization records including; tuberculosis and influenza and or influenza declination notice on file.

NO DEFICIENCIES CITED ON THIS DATE.

Exit interview conducted. This Facility Evaluation Report discussed with the Licensee and signature obtained below. Notice of site visit was issued and shall be posted remain posted for 30 days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty. A copy of this report shall be maintained for 3 years and available for public review upon request.

Please visit the CCLD website for forms, training videos and other resources: www.ccld.ca.gov

SUPERVISOR'S NAME: Antranette Robinson	TELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Geneen Redmond	TELEPHONE: (510) 873-6410
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019

LIC809 (FAS) - (06/04)

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