073407476-7-30-2021-02-CC-LCHW-C5EUS7-20210730154952

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407476
Report Date: 07/30/2021
Date Signed: 07/30/2021 03:50:01 PM

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:	BLACKHAWK MONTESSORI		FACILITY NUMBER:	073407476
ADMINISTRATOR:	BARI, NAVEEDA & PATEL, N.		FACILITY TYPE:	850
ADDRESS:	3380 BLACKHAWK PLAZA CIR,ST112		TELEPHONE:	(925) 575-7212
CITY:	DANVILLE	STATE: CA	ZIP CODE:	94506
CAPACITY:	70	CENSUS: 32	DATE:	07/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Naveeda Bari,		TIME COMPLETED:	04:15 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 July 30, 2021, at 12:50 PM., Licensing Program Analyst (LPAs) L. Chew and E.Woods conducted an joint unannounced Annual Required Inspection and met with Director Naveeda Bari, LPAs disclosed the purpose of the inspection and was granted entry into the facility by the Director. There were 32 preschool-age children in care and 6 staff members present. The facility was toured for a health and safety inspection. The hours of operation are 7:00 AM to 06:00 PM Monday -Friday. CLASSROOMS: There are four (4) classroom. There are adequate play and learning materials available. There is adequate heating/air conditioning, ventilation and lighting. The floors, furniture, and equipment are age appropriate and in good repair. Drinking water is available inside and outside. There is proper individual storage space for each child. The isolation area for sick children is in the director's office. The center is equipped with a working telephone, carbon monoxide detector, fire alarm system and two (2) fully charged 4A80BC and one (1) 3A40BC fire extinguishers. All solid waste storage containers have tight fitting covers and in good repair. BATHROOMS AND TOILETING AREAS: There are separate bathrooms for staff and children. Toilets and faucets are in safe and sanitary operating condition. Supplies are available to the children. FOOD SERVICE AREAS: There are no meals being prepared or delivered to the center however snacks is provided by facility. Menus are posted bi-weekly in advance, available for review and dated. Children bring lunch daily. LPAs observed kitchen/food preparation area to be clean and free of evidence of rodents. Cleaning supplies are not stored near snacks. OUTDOOR PLAY AREAS: There are no bodies of water, or free-standing water accessible to children. There are age appropriate toys and materials for the children. There’s a shaded rest area for children. The playground is fully fenced, and all equipment and surfaces are safe and free from hazards. Play area has a climbing play structure that is anchored with cushioned material underneath to absorb falls. See 809-C

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) -69-0243
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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 2

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: BLACKHAWK MONTESSORI	FACILITY NUMBER: 073407476
	VISIT DATE: 07/30/2021

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
26
27
28
29
30
31
32

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Three (3) staff files and three (3) children files were reviewed at 2:00 PM.
LPAs reviewed the facility roster and obtained a copy for file. Mandated Reporter Training and Certificates were reviewed. Directors CPR and First Aid certificate is current and expire on 10/26/2021. The center is in compliance with the sign in and out procedure. Disaster drills are being conducted every month latest drill completed on 7/27/2021 All required documents are posted in a publicly accessible area.

HEALTH RELATED SERVICES: LPAs inspected the medication, which is stored in a safe place that is inaccessible to children in care. Each of the medications has an unaltered label with the child’s name and date of issuance. The center is equipped with a fully stocked first aid kit that are available in the classrooms.
California Law requires Family Child Cares/Child Care Centers licensees 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 electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

Incidental Medical Services (IMS) policy was discussed. The facility provides IMS to children in care. Facility is following IMS plan on file. When any changes to the IMS plan is made, an updated plan for providing 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

Director is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility 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. Director was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

No deficiency cited during today’s inspections. A Notice of Site visit was posted at time of inspection and must remain posted for 30 days. Exit interview conducted with the Director. A copy of the report and appeal rights was provided to Director.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) -69-0243
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2