013420954-8-24-2022-52-CC-EWOS-CHLQL2-20220824121512

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013420954
Report Date: 06/30/2022
Date Signed: 08/24/2022 12:15:22 PM

Document Has Been Signed on 08/24/2022 12:15 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: 24	CENSUS: 14	DATE:	06/30/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Lorraine Quevedo		TIME COMPLETED:	12:35 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 August 24, 2022 at 10:20 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced 1 Year Required Inspection and met with the facility representative, Lorraine Quevedo. LPA disclosed the purpose of the inspection and was granted entry into the facility by the representative. There were fourteen (14) children present during this inspection and two additional staff members. 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: The one (1) classroom was inspected at 10:30 AM and teacher child ratio was observed. 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. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is the isolation tent at the front entrance of the school, away from other children in care. The center has a wired smoke detectors, a carbon monoxide detector, working telephone, and a fully charged 2A10BC fire extinguisher. BATHROOMS AND TOILETING AREAS: The staff's bathroom is separate from the children's bathroom. All sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks, and toilets and there are paper towels, soap, and other supplies in the bathroom for children. FOOD SERVICE AREAS This facility provide breakfast for the children in care. The classroom has a mini fridge, and LPA did not observe any food stored with cleaning supplies. The center sends the food menu out through class Dojo once a month and it's online. Lowfat milk is being serve at the center. Food is protected from contamination and, per staff, contaminated food is discarded immediately. Food/beverages capable of rapid spoiling are properly stored. See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022

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: 06/30/2022

NARRATIVE

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OUTDOOR PLAY AREAS: The fully fenced garden area is used for outside play. There are small bikes for children to ride and a garden to water plants. The staff brings the children cups and water to keep them hydrated and they also bring emergency backpacks for cut, bruises, and allergic reactions when providing IMS.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Five (5) children's files were reviewed around 11:00 AM. All children files contains Personal Rights, Identification and Emergency, and Medical Consent forms. Staff files are maintained and stored in the Hayward School Districts Human Resource Office, and all licensing requirements for personnel are met as a condition of employment with the school district. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. Director's CPR and First Aid certificate is current and expires on 9/2023. The center is in compliance with the sign in and out procedure. Disaster drills are being conducted at least once every 6 months in conjunction with the Hayward Unified School District schedule. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: There's no IMS being provided at this time and no medication being stored at this facility. The center is equipped with a fully stocked first aid kit that is 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.

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.

See 809-C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

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: 06/30/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

Facility representative 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 deficiency 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, Lorraine Quevedo.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2022

LIC809 (FAS) - (06/04)

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