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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710045
Report Date: 11/28/2022
Date Signed: 11/28/2022 03:22:30 PM

Document Has Been Signed on 11/28/2022 03:22 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:WALTER HAYS KIDS' CLUBFACILITY NUMBER:
430710045
ADMINISTRATOR:SCHAFFNER, CODYFACILITY TYPE:
840
ADDRESS:1525 MIDDLEFIELD ROADTELEPHONE:
(650) 325-5350
CITY:PALO ALTOSTATE: CAZIP CODE:
94301
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 6DATE:
11/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Lenina RubioTIME COMPLETED:
03:30 PM
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On November 28th, 2022 at 1:15PM, Licensing Program Analyst (LPA) April Wright arrived for an unannounced Required-1 Year inspection, and met with Director Lenina Rubio. Present today were six (6) TK children and two (2) fingerprint cleared staff members present during the inspection. The facility is in ratio today. The facility was toured for a health and safety inspection. Hours of operation are Monday through Friday, 7:30am to 6:00pm.

CLASSROOMS: Center has two (2) classrooms located in the rear of Walter Hays Elementary school campus. There are adequate play and learning materials available. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting for safety and comfort. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is black couch in reading area, away from other children in care. The center has smoke/carbon monoxide detectors, working telephone, and two (2) fully charged fire extinguishers in each classroom (Rm 1 - 3A40BC / Rm 2 - 2A10BC). At least one person trained in CPR/First aid is present at the facility when children are at the facility.

BATHROOMS: The staff's bathroom is separate from the classroom and are clean, sanitary and in good condition. All sinks and faucets are in safe and sanitary operating condition. .

FOOD SERVICE AREAS: This facility provides snack only to children in care. There are weekly snack menus posted at the facility. All storage containers for solid waste have tight fitting covers that are in good repair. Facility has a refrigerator which is clean and free of evidence of rodents, vermin or insects.

OUTDOOR PLAY AREAS: Facility shares two (2) play yards with Walter Hays school. There are two (2)play structure has grass/wood chip cushioning to absorb falls and that is anchored for stability. The facility has an overhang provides shade to children while at play. There are no pools, hot tubs or other accessible bodies of water.

See LIC809-C for continuance
Chandra Charles
April Wright
DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2022
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: WALTER HAYS KIDS' CLUB
FACILITY NUMBER: 430710045
VISIT DATE: 11/28/2022
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RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Six (6) children's files and two (2) staff files were reviewed, along with director's file. All staff files have required health screening and Employee Rights and all children files contain Identification & Emergency, Personal Rights, and Medical Consent forms. LPA reviewed the facility roster and obtained a copy. Mandated Reporter Training and CPR and First Aid certificates were reviewed and are up to date. The center is in compliance with the sign in and out procedure. Disaster drills are being conducted at least once every 6 months and the last one conducted was on 10/27/2022. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: IMS IS NOT PROVIDED AT THIS FACILITY. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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

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/inspection-process .

Director 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.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Lenina Rubio.

SUPERVISOR'S NAME: Chandra Charles
LICENSING EVALUATOR NAME: April Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2022
LIC809 (FAS) - (06/04)
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