214005495-10-13-2021-05-CC-HRCO-C7RL7Y-20211013083106

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005495
Report Date: 10/12/2021
Date Signed: 10/13/2021 08:32:15 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	ALPHA KIDS ACADEMY LLC		FACILITY NUMBER:	214005495
ADMINISTRATOR:	MAGDA BACHAKASHVILI		FACILITY TYPE:	850
ADDRESS:	1461 SOUTH NOVATO BLVD		TELEPHONE:	(415) 408-3645
CITY:	NOVATO	STATE: CA	ZIP CODE:	94947
CAPACITY:	30	CENSUS: 16	DATE:	10/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Magda Bachakashvili		TIME COMPLETED:	12:40 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 Analyst (LPA) Haydee Caliboso met with the Director, Magda Bachakashvili to conduct an unannounced annual inspection on 10/12/21. LPA arrived at the facility at 9:45AM. The purpose of the inspection was explained. Present during the inspection were 16 children and 5 staff. Facility is operating within the capacity and is following staff child ratio. LPA observed that the program is operating within ratio on this day. The facility operates Monday – Friday, 7:30 AM to 6:00 PM. LPA inspected the facility building and grounds, conducted an evaluation of the physical plant, and reviewed children, staff and facility records. LPA observed no bodies of water at the facility. Site Supervisor stated there are no firearms or weapons in the facility. The facility is equipped with smoke detector, carbon monoxide detectors, fully charged fire extinguishers and a working telephone available. The classrooms have adequate ventilation and lighting. LPA observed all cleaning solutions, poisons and other chemicals that are dangerous to the children are stored made inaccessible to the children. The classroom is equipped with age-appropriate toys and furniture. The furniture is steady and in good repair. Facility floor is in good repair and free of any hazards. LPA observed toilets and hand washing equipment are in working condition with proper sanitation in place. All storage containers for solid waste and in good repair and have proper tight fitted lid on top. The program has drinking water available for children for indoors and outdoors. The Director stated the children in the program brings their own water bottle. In addition, LPA observed pitcher of water and disposable cups readily available for children to use. Outdoor play structures are age appropriate and in good working condition, free of loose parts, free of hazard, and with sufficient cushion underneath. Cont. 809-C pg.2

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALPHA KIDS ACADEMY LLC	FACILITY NUMBER: 214005495
	VISIT DATE: 10/12/2021

NARRATIVE

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First aid kit and emergency supplies are properly maintained and kept inaccessible to children. The Director stated that there are 3 children who currently have medications with physicians and parents’ consent forms. Director stated medications are stored in a locked cabinet, medications are in original container, and consent forms are in child’s file. LPA observed medications are locked in a cabinet, made inaccessible to children, medications are in original container, and consent forms from physicians and authorized representatives are in child’s file. This facility provides IMS. A review of storage of medications, equipment and supplies was conducted. LPA reviewed children, personnel and administrative records.

LPA reviewed personnel and children’s files during today’s inspection. LPA observed all files are complete and up-do-date. LPA observed facility has record of names, addresses and telephone numbers of each child 's authorized representative. Each child's record contains the record immunization. Multiple staff members have record of valid CPR card in file. LPA reviewed the educational qualification of all the teachers. Facility has a log for emergency drills being conducted. Per log, last emergency drill was conducted on 9/24/21. The Director stated, the program is currently not providing transportation to children.

LPA reminded the Director that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. The Director was reminded about Mandated Reporter training available on the CCLD website. In addition to the AB1207 training that must be completed every two years by all staff hired, a one-time General Training is also required. Training can be taken online at www.mandaterreporterca.com. LPA observed multiple staff have completed the child abuse training. Director was reminded of Pesticides training. Information on the DPR website at: www.cdpr.ca.gov/shoolipm/childcare
Cont. 809-C pg. 3

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ALPHA KIDS ACADEMY LLC	FACILITY NUMBER: 214005495
	VISIT DATE: 10/12/2021

NARRATIVE

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The following items were reviewed as part of today's visit: Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures (smoke and carbon monoxide detectors present and in working order), Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Transportation, Parents Rights, and Reporting Requirements.

This report and rights to comment and appeal were discussed with the Director. This report must be available in the facility for public review. Notice of Site Visit shall be posted for 30 days from today's visit. Director was advised for any additional questions to call Office, M-F, 8AM-5PM at 650-266-8800. For rules and regulations, visit the website: www.cdss.ca.gov

The report was reviewed and signed by the Director. Today’s report and notice of site visit will be sent to the Director by the end of the day on 10/12/21. Confirmation of receipt is required.

>No deficiencies were cited today under Title 22 Division 12 of the California Code of Regulations.

SUPERVISOR'S NAME: Cindy Interiano	TELEPHONE: (650)266-8864
LICENSING EVALUATOR NAME: Haydee R Caliboso	TELEPHONE: (650)266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC809 (FAS) - (06/04)

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