<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423126
Report Date: 03/10/2022
Date Signed: 03/10/2022 11:40:15 AM

Document Has Been Signed on 03/10/2022 11:40 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:OAKLAND HEAD START - WEST GRAND CENTERFACILITY NUMBER:
013423126
ADMINISTRATOR:MARTINEZ, GLORIAFACILITY TYPE:
850
ADDRESS:1058 WEST GRAND AVENUETELEPHONE:
(510) 238-2268
CITY:OAKLANDSTATE: CAZIP CODE:
94607
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 15DATE:
03/10/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Thao LyTIME COMPLETED:
12:00 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 3/10/2022 at 9:35am, Licensing Program Analysts (LPAs) Melissa Domantay and Melissa Guirit arrived at the facility for an announced case management inspection. LPAs met with Thao Ly, the education coordinator. The normal hours of operation are Monday-Friday 8:00am-6:00pm. An application was received for an increase of capacity. There are 3 toilets and 3 sinks for children's use. LPAs toured the facility to conduct a health and safety inspection, and completed the following measurements:

INDOORS: 1734.54 square feet = 49 children
OUTDOORS: 2759.32 square feet = 37 children

A fire clearance was received from the Oakland Fire Department on 11/3/2021 for 12 preschoolers, ages 2 years to first grade entry and reducing the infants with toddler option from 27 to 18: 9 infants, ages birth to 24 months with toddler option, 9 toddlers, ages 18 months to 36 months.

LPAs observed that there is sufficient heating, lighting and ventilation in the classrooms, and the classroom floors and surfaces are clean and free of hazards. The rooms have an ample supply of age appropriate furniture, toys and equipment which appear to be in good condition. LPAs did not observe any bodies of water, hazardous items or toxins that would be accessible to children. LPAs observed operating sinks and covered waste cans. The rooms are equipped with fully charged 3A40BC fire extinguishers, carbon monoxide detectors and centralized smoke detection systems. The facility has a working telephone and first aid supplies. The staff office will serve as the isolation area for ill children.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: OAKLAND HEAD START - WEST GRAND CENTER
FACILITY NUMBER: 013423126
VISIT DATE: 03/10/2022
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
26
27
28
29
30
31
32
Thao is reminded that if facility plans to provide Incidental Medical Services a plan should be provided. – IMS. A Plan of Operation that includes IMS has been 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.

Gloria Martinez has a site supervisor permit, which expires 3/1/2023. Gloria has enrolled in preventative health and safety training 4/5/2022.

Mandated reporter, appeal rights, civil penalties, unusual incident reporting, fingerprint requirements, and COVID protocols were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and checking Provider Information Notices (PINs). The director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.


A license for 12 preschool children will be effective today 3/10/22. An exit interview was conducted, and a copy of the report was provided to education coordinator Thao Ly.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2