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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420954
Report Date: 08/22/2024
Date Signed: 08/22/2024 10:42:41 AM


Document Has Been Signed on 08/22/2024 10:42 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:HUSD - FAIRVIEW STATE PRESCHOOLFACILITY NUMBER:
013420954
ADMINISTRATOR:JOHNSON, DIANEFACILITY TYPE:
850
ADDRESS:23515 MAUD AVETELEPHONE:
(510) 723-3880
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY:24CENSUS: 12DATE:
08/22/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Tiffany HopperTIME COMPLETED:
10:50 AM
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On August 22, 2024 at 8:00 AM., Licensing Program Analyst (LPA) Elimika Woods and Licensing Program Manager (LPM) Chandra Charles conducted an unannounced Annual Random Inspection and met with the facility representative Tiffany Hopper. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representative. There were 12 preschool age children present during this inspection and three (3) additional staff members. The center operates out of classroom one (1) on the campus of Fairview Elementary School. The classroom and playground was toured for a health and safety inspection. The hours of operation are 8:15 AM-4:45 PM, Monday -Friday

LPA checked the facility RECORDS and they show all individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. LPA conducted a census of the children and the census matches the children signed in on the sign in sheet. 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 four (4) children's files around 9:00 AM. All children files contains Personal Rights, Medical Consent forms, and Identification & Emergency Information. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate.

The one (1) classroom was inspected around 8:30 AM and teacher child ratio was observed. There are adequate play and learning materials available. The floors are well maintained and the furniture is the correct size for preschool children. The classrooms equipment is in good repair and the room temperature is adequate for children. There is proper individual storage space for each child outside in the cubbies. The isolation area for sick children is the nurse office, away from other children in care.

LPA tested the carbon monoxide detector and found it to be functioning properly. The center has wired smoke detectors, a working telephone, and a fully charged 3A40BC fire extinguisher, which meets standards established by the State Fire Marshal in a glass case on the wall at the classroom entrance. Disaster drills are being conducted at least once every 6 months in conjunction with the Hayward Unified School District schedule and was done on 06/04/2024. All required documents are posted in a public accessible area.

See 809-C.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024
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: HUSD - FAIRVIEW STATE PRESCHOOL
FACILITY NUMBER: 013420954
VISIT DATE: 08/22/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, a 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: https://www.ada.gov/resources/child-care-centers/

This facility provides breakfast, lunch, and supper for the children. There are weekly menus posted at the facility. LPA observed an area where they have a refrigerator this area is clean and free of evidence of rodents. Low-fat milk is being served. Food is protected from contamination and, per staff, contaminated food is discarded immediately. All storage containers for solid waste have tight fitting covers that are in good repair.


The outdoor area has a play structure with a slide that has cushioning to absorb falls. The playground is fully fenced and has shaded areas for children to cool down from the heat. The staff brings the children’s water bottles and cups to keep the children hydrated while at play and the play equipment is age appropriate and in good repair. The children can also play in the fully fenced garden area on the opposite side of the building were they can water plants and ride bikes.

LPA checked the staff bathroom around 9:15 AM, and was told by the representative it was separate from the children’s bathroom. The staff bathroom is located down the hall to the left of the classroom. All sinks faucets in the children's bathroom in the class are in a safe and sanitary operating condition. There's a changing table next to the faucet in the bathroom that has supplies underneath the table.

LPA’s observations during the visit

When the children arrived in the morning they stood at the entrance with their parents waiting for the child care center staff to open the gate. After the parents signed their children in on the sign in sheet, the children had free play where they climbed, ran, and walked around the yard. LPA observed a staff member placing coloring equipment on a desk for the children to draw or color, and another staff member placing large motor equipment for children to jump on. At 9:45 AM the children came inside from outside play area and they washed their hands and participated in educational song's that were playing on the television. The children also used their small motor skills by stacking building blocks and molding Clay Doe at their tables and on the floor.



See 809-C
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
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: HUSD - FAIRVIEW STATE PRESCHOOL
FACILITY NUMBER: 013420954
VISIT DATE: 08/22/2024
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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. The licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Lead Testing – Child Care Centers (CCC) 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. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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.

The 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.

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

There are no deficiencies 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 Tiffany Hopper.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Elimika WoodsTELEPHONE: (510) 622-2550
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC809 (FAS) - (06/04)
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