013420903-8-7-2024-52-CC-JSAI-D7WQ22-20240807114624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420903
Report Date: 08/07/2024
Date Signed: 08/07/2024 11:46:33 AM

Document Has Been Signed on 08/07/2024 11:46 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 EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	EXTENDED DAY CHILD CARE - EDCC - KOLB ELEMENTARY		FACILITY NUMBER:	013420903
ADMINISTRATOR:	TAMARA BRELLAND		FACILITY TYPE:	840
ADDRESS:	3150 PALERMO WAY		TELEPHONE:	(925) 828-2666
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	120	CENSUS: 75	DATE:	08/07/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Director, Tamara Brelland		TIME COMPLETED:	11:15 AM

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	Licensing Program Analyst (LPA) Jyoti Saini met with facility representative Tamara Brelland for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Director. During the inspection, the Director and five (5) staff members were supervising 75 children. The program consists of two sessions: 7:00 am to 8:15 am and 12:00 pm to 6:00 pm Monday - Friday in room EDCC (AKA Cubs ages K-1st grade),room G3 (AKA Grizzlies ages 2nd grade to 5th grade) and Multi Purpose room (MPR) on the KOLB ELEMENTARY SCHOOL CAMPUS—the facility currently operating summer program: Monday – Friday, 7:00 am to 6:00 pm. The MPR is licensed however, is not being used at this time and was not inspected. The facility was inspected indoors and outdoors today for health and safety hazards, and the following was observed: LPA did not observe any bodies of water during today's inspection. Per director, there are no firearms on the premises. All furniture is in good repair. The Center has age-appropriate toys and equipment. The children and staff have a separate bathroom. The bathrooms are safe, sanitary, and free of any hazardous items. Drinking water is readily available through water fountains and water bottles brought from home. A menu is posted for the entire month. The school district provides lunch to the children however, during summer children are require to bring their own lunch. LPA reviewed the food storage and observed that all food was in its original packaging. The medicines are stored in locked boxes. The classroom has appropriate postings. The last Emergency Drill was conducted on 07/05/2024 at 1:15pm and is properly logged. The facility uses the KT Connect app to sign in and sign out the children. Sign in/out logs were checked and matches current census. There is a working alarm system at the elementary. The room has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available. All children have a record of emergency identification information. The staff records review was complete. All staff has a criminal record clearance on file. The opening and closing staff members have a current Pediatric First Aid/CPR certificate. All staff have taken mandated Reporter training. LPA reviewed the facility roster, and a copy was obtained. see next page..

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: EXTENDED DAY CHILD CARE - EDCC - KOLB ELEMENTARY	FACILITY NUMBER: 013420903
	VISIT DATE: 08/07/2024

NARRATIVE

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Criminal Record Clearance -

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.

Lead Testing – CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES:

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.
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
Incidental Medical Services (IMS)
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 the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
MyChildCarePlan.org
Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.
see next page..

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: EXTENDED DAY CHILD CARE - EDCC - KOLB ELEMENTARY	FACILITY NUMBER: 013420903
	VISIT DATE: 08/07/2024

NARRATIVE

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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.

No deficiency was 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 facility representative, Tamara Brelland.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti Saini	TELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

LIC809 (FAS) - (06/04)

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