013420954-8-26-2021-52-CC-EWOS-C69T79-20210826142824

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420954
Report Date: 08/26/2021
Date Signed: 08/26/2021 02:28:30 PM

Document Has Been Signed on 08/26/2021 02:28 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:	HUSD - FAIRVIEW STATE PRESCHOOL		FACILITY NUMBER:	013420954
ADMINISTRATOR:	JOHNSON, DIANE		FACILITY TYPE:	850
ADDRESS:	23515 MAUD AVE		TELEPHONE:	(510) 723-3880
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 0	CENSUS: 1	DATE:	08/26/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Lorraine Quevedo		TIME COMPLETED:	02:45 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	Licensing Program Analyst (LPA) Elimika Woods arrived to the facility at 1:00 PM to conduct an Annual Required Inspection and met with site supervisor, Lorraine Quevedo. LPA disclosed the purpose of the inspection and was granted entry into the facility by the supervisor. There was one (1) preschool age child and one additional staff member present during this inspection. The center operates out of classroom 1 on the campus of Fairview Elementary School. The classroom and playground was toured for a health and safety inspection. Hours of operation are 8:30 AM to 11:30 AM for morning session, and 12:30 PM to 3:30 PM for afternoon session. CLASSROOMS: At 1:30 PM the facility was toured. There are adequate play and learning materials available. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting at the center. There is proper individual storage space for each child. The isolation area for sick children is next to the director's desk. Drinking water is available inside and outside of the center. There's a fully charged 2A10BC fire extinguisher, a functioning carbon monoxide detector, wired smoke detector, and pull down fire alarm. All solid waste storage containers have tight fitting covers on, and appear to be in good repair. BATHROOMS AND TOILETING AREAS: There are separate bathrooms for staff and children. Toilets and faucets are in safe and sanitary operating condition. The children are able to reach the sinks and toilets. Supplies are available to the children. FOOD SERVICE AREAS: There is no kitchen at this sited but lunch is supplied by the school. The classroom has a mini fridge, and LPA did not observe any food stored with cleaning supplies or rodents. There are no menus that are posted at this time. One percent (1%) milk is being served at the facility. See 809-C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: HUSD - FAIRVIEW STATE PRESCHOOL	FACILITY NUMBER: 013420954
	VISIT DATE: 08/26/2021

NARRATIVE

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OUTDOOR PLAY AREAS: The playground area is fully fenced and all equipment and surfaces are safe and free from hazards. There's a large play structure which is anchored to the ground with cushioning to absorb falls. There are no bodies of water, or free standing water accessible to children. There are age appropriate toys and materials for the children. There’s also a shaded rest area for children.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. One (1) children's file was reviewed and all files contained personal rights, immunization records, and medical consent forms. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. Mandated Reporter Training was discussed and certificates were reviewed. Director's CPR and First Aid certificate is current and expires on 09/11/21. The center is in compliance with the sign in and out procedure.

Disaster drills have not been conducted in the last year, because the facility staff were conducting Zoom instructions only. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: no IMS is being provided at this time and no medication is being stored at the facility. The center is equipped with a fully stocked first aid kit that are available in the classroom.

California Law requires Child Care Centers licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

See 809-C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: HUSD - FAIRVIEW STATE PRESCHOOL	FACILITY NUMBER: 013420954
	VISIT DATE: 08/26/2021

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Director is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Director was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov

Incident Medical Services (IMS) policy was discussed. Per licensee, no IMS is being provided at this time. The licensee was reminded that when any changes to the IMS plan is made, an updated Plan for Providing 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)/ (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.” Licensee was reminded to visit our website at www.ccld.ca.gov to get quarterly updates on new laws and regulations.

No deficiency cited during today’s visit. A Notice of Site visit was posted at time of inspection and must remain posted for 30 days. Exit interview conducted with the site supervisor. A copy of the report was provided

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

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