073405619-8-29-2022-52-CC-MPRE-CHRRMU-20220829130918

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405619
Report Date: 08/29/2022
Date Signed: 08/29/2022 01:09:34 PM

Document Has Been Signed on 08/29/2022 01:09 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ACORN LEARNING CENTER OF DOUGHERTY VALLEY		FACILITY NUMBER:	073405619
ADMINISTRATOR:	DAWN DILLARD		FACILITY TYPE:	850
ADDRESS:	17025 BOLLINGER CANYON ROAD		TELEPHONE:	(925) 560-6488
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94582
CAPACITY:	167	CENSUS: 67	DATE:	08/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:23 AM
MET WITH:	Dawn Dillard		TIME COMPLETED:	01:08 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 8/29/2022 at 9:23am Licensing Program Analyst (LPA) Morgan Pringle met with Assistant Director Shelly Ancora for an Unannounced Annual Inspection. LPA toured the facility with Assistant Director and finished the inspection with Director Dawn Dillard. During the inspection there were sixty-seven (67) children and ten (10) staff. Eight (8) classrooms were toured for a health and safety inspection. The facility operates from 7:00am – 6:00pm, Monday – Friday. Facility is currently in the process of a change of ownership to La Petit Academy. The facility has ample age appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, medications, cleaning products, and hazardous materials were observed to be in inaccessible areas. There are five (5) children’s bathrooms on site that are clean, free from defects and in proper working order. All diaper changing areas are clean, properly padded and free from defects. All napping equipment is properly stored, clean and free from defects. All children have access to clean drinking water in and outside of the classrooms. There is a working carbon monoxide detector in the entry way of the facility. There are smoke detectors, and fully charged fire extinguishers on site as well. The outside play yards are fully fenced, clean, and free from hazards with plenty of shade. All of the play structures are sturdy and anchored into the ground. All of the sand in the play yard is free from hazards and properly maintained. LPA did not observe any harmful or unattended bodies of water in or around the facility. All proper postings are made visible in the entry way of the facility. All food provided by the facility is properly stored and labeled. The kitchen and food preparation areas are clean and free from all hazards. The fire/disaster drill log was is complete with the last drill logged on 6/9/2022. LPA obtained the electronic sign in/out log, all children have been properly signed into the facility by their authorized representative. All staff have obtained a criminal record clearance. LPA obtained the facilities files, children’s files and staff files. All files were complete. Continued on LIC809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: ACORN LEARNING CENTER OF DOUGHERTY VALLEY	FACILITY NUMBER: 073405619
	VISIT DATE: 08/29/2022

NARRATIVE

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Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

Director 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.

Continued on LIC809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: ACORN LEARNING CENTER OF DOUGHERTY VALLEY	FACILITY NUMBER: 073405619
	VISIT DATE: 08/29/2022

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.

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

Exit interview conducted and report was reviewed with Director Dawn Dillard.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

LIC809 (FAS) - (06/04)

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