010215265-8-21-2024-02-CC-DCAS-D8D2AW-20240821171412

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010215265
Report Date: 08/21/2024
Date Signed: 08/21/2024 05:14:20 PM

Document Has Been Signed on 08/21/2024 05:14 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	ALAMEDA ISLAND KIDS AT OTIS SCHOOL		FACILITY NUMBER:	010215265
ADMINISTRATOR/ DIRECTOR:	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: 84	CENSUS: 64	DATE:	08/21/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:40 PM
MET WITH:	Moriah Walton		TIME VISIT/ INSPECTION COMPLETED:	05:30 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 08/21/2024 Licensing Program Analyst (LPA) Diana Campos conducted an unannounced Annual Random Inspection at Alameda Island Kids at Otis School. LPA met with center Director Moriah Walton and explained the purpose of today's inspection. LPA was granted inspection authority to enter the facility. The facility was toured to conduct a Health and Safety Inspection. Facility's operating days and hours are Monday through Friday 7:30AM-8:45AM (before school) and 2:50PM-6:00PM (after school). The physical plant was inspected. LPA toured the premises with the Director. The facility is located on the Otis Elementary School site campus. Indoor space: Facility operates in the multi-purpose room with 64 children and 5 staff. Facility was observed to be in compliance with teacher to children ratio requirement during LPA’s inspection. The classroom, restrooms, food storage areas and spaces accessible to children were inspected. Disinfectants, cleaning solutions, poisons and other items that are dangerous to the health and safety of children in care were stored in places inaccessible to them during today's inspection. Storage areas for poisons were locked inaccessible to day care children during today's inspection. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed, the toilet facilities allow for individual privacy. All toilets, and hand washing sinks are observed to be in safe and sanitary operating condition. The facility has posted all required licensing forms. All floors were clean and safe. Foods and beverages were stored safely. Food storage areas are observed to be clean, free of litter, rubbish, and free of rodents and other vermin during today's inspection. LPA observed a fully charged 4A80BC Fire extinguisher, Smoke and Carbon Monoxide Detectors. All materials and surfaces accessible to children appeared to be toxic free. Menus were observed to be posted at least 1 week in advance in a place visible by the child’s authorized representative, dated and kept on file and made available upon request.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

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: 08/21/2024

NARRATIVE

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Outdoor Space: Outdoor playground was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards during today's inspection. Surface of the outdoor activity space was observed to be in safe condition and free of hazards during today's inspection. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were no bodies of water observed. Drinking water is readily available to children during indoor and outdoor activities via personal water bottles and water fountains.

File Review: Children sign in/out procedures and logs were reviewed. All children were signed in by their authorized representative with full legal signatures captured through Pro-Care which is an electronic application. A sample of Children's files and Staff files were taken for review. All staff have required Criminal Record clearances and Child Abuse Index Check clearances. Opening and closing staff have current EMSA approved Pediatric CPR and First Aid certificates on file.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Facility was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ALAMEDA ISLAND KIDS AT OTIS SCHOOL	FACILITY NUMBER: 010215265
	VISIT DATE: 08/21/2024

NARRATIVE

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• CCC DID NOT COMPLETE TESTING PRIOR TO THEIR DEADLINE

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility 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.

See LIC809D for 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 the Center Director Moriah Walton.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/21/2024 05:14 PM - It Cannot Be Edited

Created By: Diana Campos On 08/21/2024 at 05:09 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: ALAMEDA ISLAND KIDS AT OTIS SCHOOL	FACILITY NUMBER: 010215265
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101700(b)

Written Directives for Lead Testing

(b) All licensed Child Care Centers operating in buildings constructed before January 1, 2010, shall test their water for lead pursuant to these written directives. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that proof of the lead test report was not available during today's inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/20/2024
	Plan of Correction
1 2 3 4	director shall submit by the POC date proof of the required lead test or a plan of action to obtain a lead test of the facility water.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Sherelle Johnson

LICENSING EVALUATOR NAME:

Diana Campos

LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC809 (FAS) - (06/04)

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