073408883-1-4-2021-02-CC-LDYN-BWXF7X-20210104031503

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408883
Report Date: 10/30/2020
Date Signed: 01/04/2021 03:18:46 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	SYCAMORE VALLEY DAY SCHOOL		FACILITY NUMBER:	073408883
ADMINISTRATOR:	DEYHIM, FEDRA		FACILITY TYPE:	830
ADDRESS:	1500 SHERBURNE HILLS ROAD		TELEPHONE:	(925) 736-2181
CITY:	DANVILLE	STATE: CA	ZIP CODE:	94526
CAPACITY:	8	CENSUS: 0	DATE:	10/30/2020
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Fedra Deyhim		TIME COMPLETED:	01:15 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 10/30/20 at 10:15am, Licensing Program Analyst (LPA) Loretta Dyson arrived at the center for an announced prelicensing inspection. LPA met with the owner/director Fedra Deyhim. There were no infants present. An application was received to add an infant license to the facility, which also has a preschool component. The infant program will operate in one classrooms, Monday-Friday 7am-6pm. LPA toured the indoor and outdoor areas that will be used for the infants, to conduct a health and safety inspection and the measurements are as follows: INDOORS: 254.82 square feet= 7 children OUTDOORS: 4579.40 square feet= 61 children A fire clearance, for a capacity of 8 infants, was received on 3/6/20 from San Ramon Valley Fire. LPA observed that the classrooms have sufficient heating and ventilation for safety and comfort. The classroom floors and surfaces are clean and free of toxic substances. There is sufficient storage for children's belongings. The furniture, equipment, toys and activities are age appropriate and in good condition, and there is an ample supply available. The facility will provide lunch and snacks for children. There is 1 sink available that will be used for infants, and it is in the bathroom and within arms reach of the changing table. The sink was in sanitary and operational condition today. There is a separate bathroom for staff, and the office and staff bathroom will be used for the isolation of sick children. There are 4 cribs in the napping space and the napping space is separated from the activity space with barriers that are at least 4 feet high. There are 4 pack-in-plays that will be used for children when awake, for play and activities. LPA did not observe any bodies of water, hazardous items, toxins or medication accessible to children. The center has a functioning telephone, fully charged 3A40BC fire extinguisher, working carbon monoxide detector, and centralized smoke detection system.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 622-2633
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: SYCAMORE VALLEY DAY SCHOOL	FACILITY NUMBER: 073408883
	VISIT DATE: 10/30/2020

NARRATIVE

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The playground is fully fenced and there are trees and canopies that provide shade. LPA did not observe any defects or dangerous conditions. The infant program will use the small grass area right outside of the door of the center, the small sand area/lower play area, and other grass areas. There is an enclosed chicken coop on the yard. There is sufficient cushioning under the small play/climbing structures, to absorb a fall. LPA observed age appropriate activities and equipment that appeared to be in good condition.

The owner/director has requested an exception to act as the infant director until she completes the 3 units of infant/toddler that is required, but has proof of completion of all other requirements to be the director of the infant program.

Mandated reporting requirements, civil penalties, supervision, unusual incident and injury reporting and fingerprint requirements were discussed today. The owner is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the owner is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The owner is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

A provisional license, with a capacity of 7 infants including up to 4 crib age children, will be issued once the exception for the director's infant qualification is approved. The provisional license is valid for 90 days and will be converted to a regular license once we have proof that the required Lead Poisoning Prevention training has been completed. This report will remain on file for 3 years. An exit interview was conducted with the owner/director.

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Loretta Dyson	TELEPHONE: (510) 622-2633
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2020

LIC809 (FAS) - (06/04)

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