010215265-4-5-2022-02-CC-ASIH-CD7SV2-20220405141200

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010215265
Report Date: 04/05/2022
Date Signed: 04/05/2022 02:12:17 PM

Document Has Been Signed on 04/05/2022 02:12 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ALAMEDA ISLAND KIDS AT OTIS SCHOOL		FACILITY NUMBER:	010215265
ADMINISTRATOR:	JOURDAN, STEIN		FACILITY TYPE:	840
ADDRESS:	3010 FILLMORE STREET		TELEPHONE:	(510) 523-6510
CITY:	ALAMEDA	STATE: CA	ZIP CODE:	94501
CAPACITY: 112	TOTAL ENROLLED CHILDREN: 112	CENSUS: 7	DATE:	04/05/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Jourdan Stein		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	On 04/05/2022 Licensing Program Analyst (LPA), Arminder Singh conducted an unannounced annual/random inspection at facility. LPA met with site Director, Jourdan Stein and explained the purpose of today’s inspection. LPA notes that the Facility is located on the campus of Otis Elementary School. Facility is Licensed for room 116. Hours of operation are Monday-Friday 7:00AM-8:30AM and 12:30PM-6:00PM. During today's visit there are 7 children present with 2 fully qualified teachers and a teacher's aid. LPA toured the Facility both inside and outside during today's inspection. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. LPA reviewed two (2) children's and 1 staff files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). All staff files reviewed contain the required transcripts/verification of experience. All staff have current CPR and First Aid certifications on file. Facility understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). LPA observed that the teacher/child ratio was in compliance during today's inspection. Facility understands the conditions, limitations, and capacity specifications of the Facility license. Facility understands that children shall be visually supervised at all times. Continued on 809-C

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ALAMEDA ISLAND KIDS AT OTIS SCHOOL	FACILITY NUMBER: 010215265
	VISIT DATE: 04/05/2022

NARRATIVE

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The Facility is aware of the required sign in and sign out procedures. Children are picked up by their respective parent(s)/guardian(s) and no child is allowed to go home on his/her own.

LPA observed that room is clean and safe for all children and staff. Drinking water is readily available for the children in the outdoor playground area via drinking fountains and pitchers/disposable cups. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary, and operable. Staff bathroom can be used as an isolation bathroom if needed. Facility does not have any weapons or firearms on the premises.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children and stored in locked cabinets inaccessible to children. Any poisons are stored in the locked storage cabinet.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient materials (rubber padding) in the outdoor playground area. LPA did not observe any bodies of water during today's visit.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ALAMEDA ISLAND KIDS AT OTIS SCHOOL	FACILITY NUMBER: 010215265
	VISIT DATE: 04/05/2022

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Jourdan Stein 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.

LPA discussed the safe sleep regulations with Jourdan Stein 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 Julie Giessler 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.

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.

No deficiency cited during today’s visit

Exit Interview was conducted, where this report was discussed with Jourdan Stein.

Report was signed confirming receipt of documents.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2022

LIC809 (FAS) - (06/04)

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