434413075-3-22-2022-52-CC-JWIS-CCRRR7-20220322131439

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413075
Report Date: 03/22/2022
Date Signed: 03/22/2022 01:14:54 PM

Document Has Been Signed on 03/22/2022 01:14 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	COVENANT CHILDREN'S CENTER		FACILITY NUMBER:	434413075
ADMINISTRATOR:	ERIN ALANNA O'HEA		FACILITY TYPE:	830
ADDRESS:	670 EAST MEADOW DRIVE		TELEPHONE:	(650) 493-9505
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94306
CAPACITY:	19	CENSUS: 9	DATE:	03/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Lavon Howard		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 3/22/2022, Licensing Program Analysts (LPAs) Jonathan Williams and April Wright arrived at the facility unannounced for the purposes of conducting a Required 1-Year Inspection. LPA was met by Assistant Director, Lavon Howard. Present for this inspection are the Assistant Director, six fingerprint cleared and associated staff members, and nine infants in care. The facility was toured to conduct a Health and Safety Inspection. LPAs toured facility classrooms at 9:30am. The facility consists of three classrooms. The facility is tidy and clean with heating and ventilation for safety and comfort. There are toys and learning materials in the facility. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture and equipment accessible to children were observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. The facility has indoor space for infants that are physically separate from space used by the preschool component (434413042). The Assistant Director is aware that baby walkers, bouncers, exersaucers, and jumpers are not allowed in licensed care facilities. Food is protected from contamination and, per staff, contaminated food is discarded immediately. Food/beverages capable of rapid spoiling are properly stored. Bottles, dishes and containers of food brought by the infants’ authorized representatives are labeled with infant’s name. The infant changing tables are placed within arm’s reach of a sink while in use. Uncontaminated drinking water is available to children inside the facility. LPAs toured outdoor play area at approximately 9:42am. Outdoor play was found to be in safe condition during this inspection. All play equipment is operable and age-appropriate at this time. Poured rubber completely surrounds play structures to absorb falls. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection. Uncontaminated drinking water is available to children in the outdoor area.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

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 4

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: COVENANT CHILDREN'S CENTER	FACILITY NUMBER: 434413075
	VISIT DATE: 03/22/2022

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
26
27
28
29
30
31
32

The facility has multiple fully charged 3A40BC and 2A10BC fire extinguishers, working carbon monoxide detector, and working telephone. Smoke detector/alarm is wired to notify the fire department when triggered and was last inspected 12/09/21. All components of the smoke detector/alarm were marked "PASS". Multiple staff present today have current CPR/1st Aid certificates. The facility is in ratio today, with one teacher supervising no more than 4 infants. Children were observed to be visually supervised at all times, with no infants being left unattended. Children's files and staff files were reviewed for proper documentation. All required forms are posted in public view, including menus. Fire/disaster drill is conducted at least once every six months (last drill conducted 2/18/2022). Facility roster was obtained.

Sign in/sign out logs were reviewed. LPA observed nine digital signatures out of nine children present today.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS to children in care at this time. Assistant Director is notified that if any children require IMS, a Plan for Providing 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.”

Assistant 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.

Assistant Director was reminded that California Law requires licensed Child Care Centers to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Assistant Director that all forms can be downloaded at www.ccld.ca.gov and encouraged the Assistant Director to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Assistant Director was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: COVENANT CHILDREN'S CENTER	FACILITY NUMBER: 434413075
	VISIT DATE: 03/22/2022

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
26
27
28
29
30
31
32

LPAs discussed the safe sleep regulations with Assistant Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Assistant Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

There are no deficiencies cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Assistant Director. Appeal rights were provided to the Assistant Director and the signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan Williams	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4