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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405640
Report Date: 06/20/2019
Date Signed: 06/20/2019 11:14:02 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:GROWING ROOM AT LIVE OAK, THEFACILITY NUMBER:
073405640
ADMINISTRATOR:FERREIRA, LISAFACILITY TYPE:
840
ADDRESS:5155 SHERWOOD WAYTELEPHONE:
(925) 803-0982
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY:194CENSUS: 41DATE:
06/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Lisa FerreiraTIME COMPLETED:
11:25 AM
NARRATIVE
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Licensing Program Analyst (LPA) Julia Placencia arrived at 8:55am for an unannounced Annual/Random inspection, and met with Director Lisa Ferreira. There were 41 children and 6 staff present during the inspection. The facility was toured for a health and safety inspection. Hours of operation are 6:30am to 6:30pm.

Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the visit. The toilets and sinks were in operable condition. The floors are free of tripping hazards. The kitchen/food preparation and storage areas appear to be clean and free of evidence of rodents and food is protected against contamination. All storage containers for solid waste have tight-fitting covers that are in good repair. Drinking water is available both indoors and outdoors. Snack menus are posted and visible for parents to review. There are no pools or similar bodies of water at this facility. Outdoor activity space and playground equipment observed to be safe and free of hazards. Climbing equipment is properly anchored to the ground with adequate and appropriate cushioning material to absorb falls. There is a shaded area provided for the children. Required licensing documents were posted. Fire extinguishers, carbon monoxide and smoke detectors meet State Fire Marshall standards. Fire/Disaster drills are conducted monthly, and the log indicates the last drill was conducted on 5/28/19. The facility is operating within its licensed capacity. The teacher/child ratio was being met, and LPA did not observe any child left without supervision. LPA verified both opening and closing staff have current CPR/First aid training. At 10:00am, children and staff files were reviewed. Teachers have required immunizations, current mandated reporter training, and meet qualification requirements.

The following deficiency was observed during today's inspection:
  • At 10:25am, LPA observed child identified as C1 does not have written instructions and approval from her authorized representative for the medication epinephrine.

***Continued on LIC809C...
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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 3
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: GROWING ROOM AT LIVE OAK, THE
FACILITY NUMBER: 073405640
VISIT DATE: 06/20/2019
NARRATIVE
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The Director is reminded that ALL Staff must be fingerprint cleared prior to being in the presence of children in care, or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

See LIC809D for deficiencies cited during today's inspection. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected. This report shall remain on file for 3 years. A Notice of Site visit was provided at time of inspection and must remain posted for 30 days.

Exit interview conducted with Lisa Ferreira. Copy of report and appeal rights provided.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: GROWING ROOM AT LIVE OAK, THE
FACILITY NUMBER: 073405640
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/27/2019
Section Cited
CCR
101226(e)(3)(B)
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Health-Related Services -
For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.
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Director will obtain written instructions and approval for C5's epinephrine medication, and submit copy to CCL by due date of 6/27/19.
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This requirement is not met as evidenced by:
Based on observation and interviewed, there is no written instructions and approval form on file for C5's epinephrine medication, which poses a potential health and safety risk to child in care.
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 Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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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: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
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