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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414055
Report Date: 02/14/2025
Date Signed: 03/06/2025 11:38:01 AM

Document Has Been Signed on 03/06/2025 11:38 AM - 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HUSD CHILD DEVELOPMENT CTR. - PALMA CEIAFACILITY NUMBER:
013414055
ADMINISTRATOR/
DIRECTOR:		HAZATONE, JOHNFACILITY TYPE:
850
ADDRESS:27679 MELBOURNE AVENUETELEPHONE:
(510) 293-9822
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
02/14/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Mitchell HaTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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This is an amended report to the original visit on 02/14/2025.

Licensing Program Analyst’s (LPA’s) Brindha Govindasamy, Jialing Zhu and Licensing Program Manager’s (LPM’s) Wynn Norona and Chandra Charles met with Interim director Mitchell Ha for an unannounced case management inspection of changing from the Portable room to Room #12. Director requested a preschool room change license to serve 24 preschool children from age three to five years old. There is no change in capacity. The center is located on the Palma Ceia Elementary school site and shares the same main entrance. The program will operate Monday through Friday from 8:00 a.m. to 5:00 p.m. At the time of inspection, there were no additional staff or children in care. The fire clearance was granted and approved by Hayward Fire Department on January 22, 2025. The facility will provide breakfast, lunch, and afternoon snacks.

LPA reviewed with applicant the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

INDOOR ACTIVITY SPACE:
There is one preschool classroom (classroom #12). LPA’s observed enough equipment, toys, tables and chairs. There is a fully stocked first aid kit and a fully charged 2A10BC fire extinguisher in the classroom. Medications will be stored in the office/Nurse room in a locked box. LPA observed cleaning disinfectants needs to be locked appropriately and inaccessible to children. Director stated there are no poisons or firearms on the premises. LPA observed water fountain in the classroom. LPA observed a functional carbon monoxide detector in the block area. Director stated paper sign-in/sign-out system will be utilized for sign-in/sign-out.
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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2025
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HUSD CHILD DEVELOPMENT CTR. - PALMA CEIA
FACILITY NUMBER: 013414055
VISIT DATE: 02/14/2025
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LPA measured one classroom. The total classroom space contains a total of 850.85 square feet, which will accommodate director’s request for 24 preschool children. There is one toilet and two sinks for the children, and a separate private restroom for the staff located outside of the classroom. LPA observed a television mounted on the wall in the front of the classroom and addressed it in the event of an earthquake to secure it properly. The applicant is requesting to use the elementary school’s restroom which has four toilets, 3 urinals and six sinks to accommodate the requesting capacity. The applicant has submitted a waiver request to share the elementary school’s restroom. Applicant stated children who become ill during the day will be isolated in the office area and will use the Nurse room restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
Total outdoor space was 10097.71 which will accommodate director's request for 24 preschool children. The facility will be sharing outdoor space with TK and Kindergarten program and existing waiver is on file. Drinking water is accessible by water fountain and children bringing their own water bottles. The outdoor play area is fenced. LPA observed sufficient amount of equipment and toys. The play structure includes a safety label with the age-appropriate rating. Director was advise to follow manufacturer guideline. There are no bodies of water on the premises. Shade is supplied by awning and trees. LPA observed one locked storage shed which store outdoor equipment and electrical heater inaccessible to children in care.

APPLICANT WILL WAIT UNTIL FACILITY OPENS TO DETERMINE IMS NEEDS: Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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 Childcare Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HUSD CHILD DEVELOPMENT CTR. - PALMA CEIA
FACILITY NUMBER: 013414055
VISIT DATE: 02/14/2025
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LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children’s ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Lead Testing: Assembly Bill (AB) 2370, Chapter 676, Statues of 2018, requires all licensed Child Care Center( 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. LPA referred director to the Department website for lead : Lead Toxicity Prevention and Water Testing Information.

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

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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HUSD CHILD DEVELOPMENT CTR. - PALMA CEIA
FACILITY NUMBER: 013414055
VISIT DATE: 02/14/2025
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Childcare option to receive email communication.

Exit interview was conducted, report was reviewed and Notice of Appeals right was provided to Interim Director Mitchell Ha.

The following items are required before a license will be issued:

1. Final review by Manager.

2. Review of waiver request for shared restroom.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Brindha Govindasamy
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
LIC809 (FAS) - (06/04)
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