013419494-4-18-2023-52-CC-MOTI-CQZTH6-20230418144412

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419494
Report Date: 04/18/2023
Date Signed: 04/18/2023 02:44:28 PM

Document Has Been Signed on 04/18/2023 02:44 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:	PALM ACADEMY		FACILITY NUMBER:	013419494
ADMINISTRATOR:	YEN NGUYEN		FACILITY TYPE:	840
ADDRESS:	2856 WASHINGTON BLVD		TELEPHONE:	(510) 979-9794
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY:	72	CENSUS: 0	DATE:	04/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:31 AM
MET WITH:	Seliya Yoo		TIME COMPLETED:	03:01 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 4/18/2023, Licensing Program Analyst (LPA) Melanie Otsuji arrived at the facility unannounced for the purposes of conducting a Required 1-Year Inspection. LPA was met by Director, Seliya Yoo. Present for this inspection was the Director. There were no school age children present as the children do not attended until the afternoon. Facility operating hours are Monday through Friday 8:00AM - 6:00PM. The facility was toured to conduct a health and safety inspection. LPA toured the facility classrooms. The classrooms are tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the classrooms. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. LPAs observed adequate amounts of paper towels and hand soap available to children in the bathroom during today's inspection. Facility utilizes an electronic sign in/out system. Each authorized representative has a unique identifier. LPA toured the food preparation area. Lunch and AM/PM snack is provided for children. Refrigerator was observed to be maintained in working order and was found to be free of evidence of rodents and other vermin at this time. Menus are posted in public view. The facility has multiple fully charged fire extinguishers and working telephone. Carbon monoxide detectors are fully functional. Smoke alarm system is serviced regularly, per Director. At least one staff member present today has current CPR/1st Aid certificate. Children's files and staff files were reviewed for proper documentation. All required forms are posted in public view. Facility roster was requested.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

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: PALM ACADEMY	FACILITY NUMBER: 013419494
	VISIT DATE: 04/18/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care at this time. IMS Plan of Operation is on file at this time. 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/childqanda.htm.”

Director 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.

There are no deficiencies cited. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director. Appeal rights were provided to the Director and the signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2023

LIC809 (FAS) - (06/04)

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