073405628-7-19-2022-52-CC-MPRE-CGGRAE-20220719125101

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073405628
Report Date: 07/19/2022
Date Signed: 07/19/2022 12:51:12 PM

Document Has Been Signed on 07/19/2022 12:51 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:	SRVSACCA - KIDS COUNTRY AT QUAIL RUN		FACILITY NUMBER:	073405628
ADMINISTRATOR:	SAMS, DANIELLE		FACILITY TYPE:	840
ADDRESS:	4040 GOLDEN BAY AVE.		TELEPHONE:	(925) 552-4488
CITY:	SAN RAMON	STATE: CA	ZIP CODE:	94582
CAPACITY:	174	CENSUS: 52	DATE:	07/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Joathan Truong		TIME COMPLETED:	12:42 PM

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On 7/19/2022 at 9:39am Licensing Program Analyst (LPA) Morgan Pringle met with Director Jonathan Truong for an Unannounced Annual Inspection. There were fifty-two (52) school age children and seven (7) other staff present during the inspection. The facility is on the Quail Run Elementary School campus and is currently running their summer school program. Three (3) classrooms, Room one (1), two (2) and three (3), were toured for a health and safety inspection. Classroom one (1) is currently not in use by the children. The facility operates in the summer from 7:30am – 6:00pm, Monday – Friday. Their normal operating hours are 6:30am – 6:30pm, Monday – Friday.

The facility has ample age appropriate materials in the classroom 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 three (3) toilets, one (1) urinal and four (4) sinks at the facility. Both bathrooms are clean and in proper working order. There is also one (1) adult sized sink in each classroom. All children have access to clean drinking water in and outside of the classroom. There is a working carbon monoxide detector in the kitchen, smoke detectors in every room and eight (8) fully charged fire extinguishers in the facility. The outside play yard is clean and free from hazards with plenty of shade. The outside play yard is partially fenced and is connected to a public park. LPA did not observe any harmful or unattended bodies of water in or around the facility and there is one snake in room (3). The snake is fully enclosed and supervised at all times.

The facility is operating within its licensed capacity and is in ratio. All proper postings are made visible by the entrance door of the facility. The kitchen is neat, clean and free from hazards. The facility only provides snacks for the children and all other food is brought from home. Director stated that during the summer lunch is provided to the children occasionally. All food provided by the facility is properly stored and labeled. The fire/disaster drill log was complete with the last drill logged 5/18/2022.

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: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

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: SRVSACCA - KIDS COUNTRY AT QUAIL RUN	FACILITY NUMBER: 073405628
	VISIT DATE: 07/19/2022

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A physical census of the children and staff were taken and cross referenced with the sign-in and out log. All children were properly signed in. All staff on site have obtained a criminal record clearance. LPA obtained the facilities files, children’s files and staff files. All files were complete, and no deficiencies were cited during the inspection.

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.

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: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

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: SRVSACCA - KIDS COUNTRY AT QUAIL RUN	FACILITY NUMBER: 073405628
	VISIT DATE: 07/19/2022

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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.

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

Exit interview conducted and report was reviewed with Director Jonathan Truong.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Morgan Pringle	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

LIC809 (FAS) - (06/04)

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