073408219-3-10-2020-02-CC-LCHW-BMKSTW-20200310141014

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408219
Report Date: 03/10/2020
Date Signed: 03/10/2020 02:10:27 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:	SAFARI KID - DANVILLE		FACILITY NUMBER:	073408219
ADMINISTRATOR:	KOTHARI, PRIYA		FACILITY TYPE:	850
ADDRESS:	4135 BLACKHAWK PLZ CIR STE 150		TELEPHONE:	(408) 688-4432
CITY:	DANVILLE	STATE: CA	ZIP CODE:	94506
CAPACITY:	38	CENSUS: 13	DATE:	03/10/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	SAFARI KID - DANVILLE		TIME COMPLETED:	02:25 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	Licensing Program Analysts (LPAs) LaKeisha Chew and R. Hollie met with center Director, Kothari, Priya, for the purpose of an unannounced annual Required Health and Safety Inspection. The center was toured inside, there is not an outside play area. A physical census was taken of all children present and crossed referenced with the sign in and out sheets. The center is equipped with a fully stocked first aide kit. Staff and sampling of children files was reviewed. A review of five (5) children and four (4) staff records was conducted. All required documentation for staff and children were in file. See next page for continuation...

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

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 5

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: SAFARI KID - DANVILLE	FACILITY NUMBER: 073408219
	VISIT DATE: 03/10/2020

NARRATIVE

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A review of staff records indicates that one (1) staff member fingerprints are not cleared. The staff member had her fingerprints taken through live scan, however, the facility number was not placed on the document. Therefore, the staff member is not fingerprint cleared. A call to CCL confirmed there was no record of a fingerprint clearance for staff member. Today, the facility will be accessed a civil penalty of $100.00 for not ensuring a staff member is fingerprint cleared. The staff member will be re-fingerprinted with the correct facility number and cleared prior to returning to work.
Classroom Furniture & Equipment was age and sized appropriate. The Heating and lighting was adequate. There is drinking water readily available in each classroom. There is adequate storage for children's belongings.
See next page for continuation...

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: SAFARI KID - DANVILLE	FACILITY NUMBER: 073408219
	VISIT DATE: 03/10/2020

NARRATIVE

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The facility appears to be safe and sanitary and in good repair. Bathroom and Toileting areas. The bathroom was toured and toilets flush properly and all faucets are in working order. There is a separate staff bathroom. There is no standing water on the floor. There is separate paper towels and liquid soap available for children's use. Food service area parents bring snack for children. There are no cleaning supplies stored next to food.
There is no outdoor play area to be inspected.
No napping provided at the facility. Posting requirements was highly visible for parental review. Disaster Drills are being practiced at least once every 6 months with the last one being conducted 02/2020. Children and staff were counted to ensure proper ratios and compliance with capacity limits. Child teacher interactions were observed and found to be in accordance with regulations. No children's rights were being violated. At least one person on staff has current CPR/First Aide. See next page for continued report.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: SAFARI KID - DANVILLE	FACILITY NUMBER: 073408219
	VISIT DATE: 03/10/2020

NARRATIVE

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Today the facility will be cited a Type A deficiency for having a staff member present without a criminal record clearance. Please see page two (2) for details. The facility will also be charged a civil penalty of $100.00. Staff member shall be re-fingerprinted with the correct facility number on the document and can not return until the fingerprints are cleared, Each parent with children in care and future parents for the next one (1) year shall receive a copy of this report. Parents shall sign and Acknowledgement of Receipt of Licensing report and this document shall go into each child's file. Failure to do so will result in a $100.00 civil penalty per family. The facility does not have children that require Individual Medical Services (IMS) The attached type A violation is cited today and must be corrected by the due date. Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgment form of proof of receiving this report (LIC9224). The LIC 9224 must be placed in the child's file to be reviewed by licensing.
An exit interview was conducted with the licensee/director. The licensee was provided a copy of her/his appeal rights and the signature on this form acknowledges receipt of these rights. A Notice of Site visit was posted at the time of inspection and must remain posted for 30 days.
Please see 809-D for deficiencies.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

LIC809 (FAS) - (06/04)

Page: 4 of 5

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: SAFARI KID - DANVILLE	FACILITY NUMBER: 073408219
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/10/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/11/2020 Section Cited	1 2 3 4 5 6 7	CRIMINAL RECORD CLEARANCE 101170(e)1 (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department THIS REQUIREMENT IS NOT BEING MET.
	8 9 10 11 12 13 14	The facility has a staff member present whom live scan receipt is in file however, the document lacks the required facility number that would associate staff member to facility. P/C to CCL confirmed there is no record of a fingerprint clearance for staff member, Therefore, the facility will be cited a Type A deficiency for having a person present without a fingerprint clearance which is an immediate risk to children in care.	8 9 10 11 12 13 14
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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: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Lakeisha Chew	TELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020

LIC809 (FAS) - (06/04)

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