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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412358
Report Date: 09/10/2024
Date Signed: 09/10/2024 04:34:37 PM

Document Has Been Signed on 09/10/2024 04:34 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:DAVIS STREET AT JEFFERSONFACILITY NUMBER:
013412358
ADMINISTRATOR/
DIRECTOR:		LANGHAM, SHEILAFACILITY TYPE:
850
ADDRESS:14300 BANCROFT AVENUETELEPHONE:
(510) 483-3637
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 41TOTAL ENROLLED CHILDREN: 41CENSUS: 25DATE:
09/10/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Daisy AmezcuaTIME VISIT/
INSPECTION COMPLETED:
04:53 PM
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On today's date, 9/10/2024, Licensing Program Analyst (LPA) Melanie Otsuji met today with Director of Child Development Centers for an Annual/Required and Case Management for an increase in capacity inspection. The center has submitted an application for an increase in capacity from 41 children to 85 children. An additional room is being added to the center license. The center will now be operating in 3 rooms (1 building) . Hours of operation are from 7:00am-5:30pm, Monday through Friday. Children's files were reviewed today. Staff files were also reviewed today. Proper teacher-child ratio was observed during this visit. A health and safety inspection was conducted inside and outside. The following is the total overall measurement:

INDOORS: 2380.24 square feet = 68 children
OUTDOORS: 4504.11 square feet = 60 children

The classrooms and play yard were age appropriate and in good repair. Bathrooms were clean and in working order. There is a separate staff bathroom. Facility provides lunch and AM/PM snacks to children in care. The kitchen area was maintained in a clean manner and was inaccessible to children in care. Menus were posted. There is adequate variety and quantity of foods to meet the children's needs. Waste containers have tight fitting lids. The storage of napping equipment was observed. The electronic sign in and out logs were reviewed. All posting requirements are met. Outdoor play area was free of hazards and provided a shaded area for the children and access to drinking water. A waiver request allowing for no more than 60 children at a time on the play yard is being requested. The facility has charged fire extinguishers and first aid kits. There is a working telephone at the facility. Opening and closing staff have current CPR and first aid training.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: DAVIS STREET AT JEFFERSON
FACILITY NUMBER: 013412358
VISIT DATE: 09/10/2024
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Facility Representative 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2021/CCP/PIN-21-21_1-CCP.pdf. LPA referred facility representative to the Department website for lead: https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

LPA discussed the safe sleep regulations with facility representative 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 facility representative 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and
equipment/supplies, and reviewed children’s, personnel, and administrative records.
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) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and IMS. Facility representative 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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: DAVIS STREET AT JEFFERSON
FACILITY NUMBER: 013412358
VISIT DATE: 09/10/2024
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No citations are noted on today's date. A license for 68 preschool children will be issued pending approval of waiver request for play yard.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility Representative, Daisy Amezcua.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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