073408225-4-19-2023-02-CC-CCON-CR2RPK-20230419131205

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408225
Report Date: 04/19/2023
Date Signed: 04/19/2023 01:12:20 PM

Document Has Been Signed on 04/19/2023 01:12 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	EARLY CHILDHOOD MENTAL HEALTH PROGRAM -		FACILITY NUMBER:	073408225
ADMINISTRATOR:	SAMANTHA WATSON-ALVARADO		FACILITY TYPE:	850
ADDRESS:	200 - 24TH STREET		TELEPHONE:	(510) 412-9200
CITY:	RICHMOND	STATE: CA	ZIP CODE:	94804
CAPACITY:	15	CENSUS: 5	DATE:	04/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Reniquea Taylor		TIME COMPLETED:	01:24 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 Wednesday, April 19, 2023, Licensing Program Analyst (LPA) Caroline Colson, arrived at the facility at 9:40 AM and met with Reniquea Taylor, Therapeutic Teacher, to conduct an annual required inspection. A guided tour was provided by the Therapeutic Teacher. Hours of Operation are Mondays - Fridays from 8:30 AM to 4:00 PM. The morning program is Mondays - Fridays from 8:30 AM to 12:30 PM. LPA made the following observations: Capacity/Staffing: The facility is a preschool in one classroom. There are 5 preschool children present with 5 staff members. Physical Plant: There is a bathroom within the classroom. There is adequate heating, lighting and ventilation. There are no cleaning solutions, chemicals or other hazards accessible to children. Classrooms: Furniture and equipment age appropriate and in good repair. There are separate storage areas for children’s belongings. Children do not take naps at facility. The facility provides breakfast, lunch and snacks. The menu is posted for review. Restrooms: Toilets and sinks are operable. There is soap, toilet paper and paper towels for sanitary use. Play yard: Climbing structures, swings, slides are safe and in good condition. There is a shaded area. Playground is free of debris and other hazards. Drinking water is readily available. There are no pools, hot tubs or other bodies of water present. CONTINUED

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: EARLY CHILDHOOD MENTAL HEALTH PROGRAM -	FACILITY NUMBER: 073408225
	VISIT DATE: 04/19/2023

NARRATIVE

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Emergency Preparedness/Safety: There are Smoke Detectors and Carbon Monoxide Detectors in the classroom and were checked on April 19, 2023. The 3A40BC fire extinguishers was serviced in 2022. First Aid Kit is available and complete. Emergency Disaster Plan is posted. The facility utilizes a land line telephone.

Postings: Facility License, Emergency Disaster Plan, Notification of Parent's Rights, Earthquake Preparedness Checklist.

Sign in Sheet/Class Roster: All parents are providing full legal signatures. The roster is current and available.

Training/Record Review:
All staff present on this date have criminal background clearances and are associated to the facility. Staff have current CPR/First Aid and Mandated Reporter Training certificates on file.

The facility is not currently providing Incidental Medical Services to children in care. Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (US DOJ) 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

Center Director will send a copy of the Operations and Record Keeping Orientation Certificate to our department by mail.

Please See LIC 809 C For Additional Information

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: EARLY CHILDHOOD MENTAL HEALTH PROGRAM -	FACILITY NUMBER: 073408225
	VISIT DATE: 04/19/2023

NARRATIVE

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Reniquea Taylor 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.

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 copy of this report shall be maintained for 3 years and available for public review upon request.

A Notice of Site Visit was issued and shall remain posted for 30 days. Failure to keep this notice posted for the 30 consecutive days will result in an immediate $100 civil penalty.

Please visit our website at www.ccld.ca.gov for training videos, forms, and other resources.

Exit interview conducted and report was reviewed with the facility representative, Reniquea Taylor .

Please See LIC 809 D for Deficiencies

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/19/2023 01:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: EARLY CHILDHOOD MENTAL HEALTH PROGRAM -	FACILITY NUMBER: 073408225
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above because there are staff missing immunization records which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	Licensee will send all missing immunization records by due date.

Type B

Section Cited

CCR

101220.1(g)

Immunizations

(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in because one child didn't have immunization records which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	Licensee will send the immunization records by due date.

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: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/19/2023 01:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: EARLY CHILDHOOD MENTAL HEALTH PROGRAM -	FACILITY NUMBER: 073408225
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101221(b)(6)

Child's Records

(b) Each record shall contain information including, but not limited to, the following: (6) A signed copy of the admission agreement specified in Section 101219. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having the required statment regarding Community Care Licensing which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/19/2023
	Plan of Correction
1 2 3 4	Licensee will update the Admission Agreement to reflect the required documentation regarding Community Care Licensing.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Mayla Mendoza	TELEPHONE: (510) 292-2724
LICENSING EVALUATOR NAME: Caroline Colson	TELEPHONE: (510) 725-7008
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC809 (FAS) - (06/04)

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