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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213411
Report Date: 05/08/2024
Date Signed: 05/08/2024 12:13:40 PM

Document Has Been Signed on 05/08/2024 12:13 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:HACIENDA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
010213411
ADMINISTRATOR/
DIRECTOR:		IMELDA ACOSTAFACILITY TYPE:
830
ADDRESS:4671 CHABOT DRIVETELEPHONE:
(925) 463-2885
CITY:PLEASANTONSTATE: CAZIP CODE:
94588
CAPACITY: 52TOTAL ENROLLED CHILDREN: 52CENSUS: 4DATE:
05/08/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Imelda AcostaTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On May 8, 2024, Licensing Program Analysts (LPAs) Lorraine Dacanay-Breaux and Jialing Zhu conducted an unannounced 1 Year Required Inspection and met with Director, Imelda Acosta. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Director. There were four (4) children present during this inspection and six (6) additional staff members. The infant has one large classroom. This center has a Preschool component license number #010213410. The facility was toured for a health and safety inspection. The hours of operation are 7:30 AM-6:00 PM, Monday -Friday.

CLASSROOMS: The infant has one large classroom, this classroom was inspected for health and safety. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting. Drinking water is available inside and outside of the center. There are adequate play and learning materials available for each child, and individual storage space. The isolation area for sick children is in the classroom away from other children in care until the children are picked up. The center has a smoke/ carbon monoxide detector (tested and working, working telephone, pull down fire alarm system, first aide kits in classroom and four (4) fully charged 2A10BC fire extinguishers.

BATHROOMS AND TOILETING AREAS: The staff's bathroom is separate from the children's bathroom. All sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets. Supplies are available to the children. The diaper changing table is in arms reach of the sinks.

FOOD SERVICE AREAS: This facility provides morning and afternoon snacks for the children. There are weekly menus posted at the facility. LPA observed areas where they have refrigerators that are clean and free of evidence of rodents. There are no pesticides and other similar toxic substances stored in food storerooms. Lunch is not provided by the center. All storage containers for solid waste have tight fitting covers that are in good repair.

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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 3
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: HACIENDA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 010213411
VISIT DATE: 05/08/2024
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Outdoor Play Area: The playground outside is fenced and all equipment and surfaces are free from hazards. There are no bodies of water, or free-standing water accessible to children. There are age appropriate toys and materials for the children. Per director there are no pools at the facility.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. One (1) children's files and three (3) staff files were reviewed around 9:30 AM. All staff files have required Health Screening, Employee Rights, and Criminal Record Statements and all children files contain Identification & Emergency, Parent Rights and Medical Consent forms. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. Mandated Reporter Training was discussed, and certificates were reviewed. The facility representative's CPR and First Aid certificate is current and expires on 02/2025. 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 02/16/2024. All required documents are posted in a public accessible area.



HEALTH RELATED SERVICES: IMS is not being provided for this component.

California Law requires Child Care Centers licensees 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. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

Incidental Medical Services (IMS): This facility does provide Incidental Medical Services (IMS). LPA inspected storage of medications and equipment/supplies, and reviewed children’s, personnel, and administrative records. All children’s medications are securely stored, accompanied by their prescription labels, and are in compliance with expiration dates. For IMS information see PIN 22-02-CCP. 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/resources/child-care-centers/.

See 809-C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
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: HACIENDA CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 010213411
VISIT DATE: 05/08/2024
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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.

Facility representative 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.

MyChildCarePlan.org: Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

There's no deficiency cited today. Appeal Rights Provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Imelda Acosta.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
LIC809 (FAS) - (06/04)
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