480105679-2-25-2022-01-CC-MAUN-CBYTMA-20220225135050

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 480105679
Report Date: 02/25/2022
Date Signed: 02/25/2022 01:51:04 PM

Document Has Been Signed on 02/25/2022 01:51 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME:	VUSD-CDC-FEDERAL TERRACE P/S		FACILITY NUMBER:	480105679
ADMINISTRATOR:	TRUJILLO,MARISA		FACILITY TYPE:	850
ADDRESS:	415 DANIEL AVENUE		TELEPHONE:	(707) 556-8755
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94590
CAPACITY:	30	CENSUS: 6	DATE:	02/25/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Monique Garcia		TIME COMPLETED:	02:30 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	A Required-1 Year inspection was made to the facility by Licensing Program Analyst (LPA), M. Augustin. The facility file was reviewed prior to this visit. The preschool program is located on the Federal Terrace Elementary school campus in classroom #2 and is operated by the Vallejo Unified School District public agency; and is a Title 5 funded program. The facility has a waiver to allow the preschool to share the bathrooms with the Federal Terrace Elementary School campus. The Center Director (CD) stated that the Vallejo Unified School District ensured that all district personnel obtained a criminal record clearance prior to working at the facility. Center 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. The facility’s operating hours are 7:00am - 5:30pm, Monday-Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. LPA did not observe any poison(s). The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is drinking water available to children both indoors and outdoors. The facility provides filtered water bottles to the children. The children’s bathroom is in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. A Menu was posted in an area accessible for review by the child(ren)’s authorized representative(s). The Daily Activities schedule, the Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist, Personal Rights, Parents’ Rights (PUB 393), California Child Passenger Safety Law, and Local county public health contact information, were posted in a prominent area near the facility entrance. Garbage cans containing solid waste have tight fitting lids. LPA observed a working carbon monoxide detector and smoke detector, and a fully charged fire extinguisher rated at least 2A10BC. (Continue to LIC 809-C)

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: VUSD-CDC-FEDERAL TERRACE P/S	FACILITY NUMBER: 480105679
	VISIT DATE: 02/25/2022

NARRATIVE

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The playground equipment and surface areas were in safe condition. There foam cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The Center Director stated no weapons are stored on site and none were observed. The facility roster of the children currently in care was reviewed and appeared to be complete. During today's inspection, staffing ratios were being met, and six children were being supervised by one fully qualified Teacher and one Aide.

The facility was operating within the licensed capacity. The Center Director furnished a current EMSA approved Pediatric CPR and First Aid certification that expire on 10/2022. The sign-in/sign-out procedure contained time signed in/out and children’s authorized representative’s full signature and was in compliance. Three staff (CD, S1-S2) records were reviewed at 10:58am and staff records contained required immunization records, current AB 1207 Mandated Reporter Training certificate, Employee Rights (LIC 9052), and documents which verified staff qualification(s). Six (C1-C6) children’s records were reviewed at 11:40am and records contained Physician’s Report (LIC 701), Immunization record (IR), IR transcribed onto blue CDPH 286, Child’s Preadmission Health History Parent’s Report (LIC 702); and Admission agreements. The facility conducted an emergency disaster drill within last six months and the last drill was conducted on 02/08/22.

The facility is currently not providing Incidental Medical Services to the children in care. The Department’s IMS policy was discussed with the Director. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the Center Director. Exit interview conducted and report was reviewed with the Center Director, Monique Garcia.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. There were no violation(s) of the California Code of Regulations, Title 22; Division 12, observed. (Continue to LIC 809-C)

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: VUSD-CDC-FEDERAL TERRACE P/S	FACILITY NUMBER: 480105679
	VISIT DATE: 02/25/2022

NARRATIVE

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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

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC809 (FAS) - (06/04)

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