013423127-3-30-2022-02-CC-MGUT-CCZQPH-20220330122047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423127
Report Date: 03/30/2022
Date Signed: 03/30/2022 12:20:57 PM

Document Has Been Signed on 03/30/2022 12:20 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	OAKLAND HEAD START - 85TH AVENUE		FACILITY NUMBER:	013423127
ADMINISTRATOR:	ROSS, LISA		FACILITY TYPE:	830
ADDRESS:	8501 INTERNATIONAL BOULEVARD		TELEPHONE:	(510) 238-3165
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94621
CAPACITY:	24	CENSUS: 0	DATE:	03/30/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Thao Ly		TIME COMPLETED:	12:30 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 03/30/22, a Prelicensing Visit was conducted today by Licensing Program Analysts (LPA), Melissa Guirit and Melissa Domantay. LPAs met with applicant, Thao Ly. The applicant submitted an application for an infant license. A health and safety inspection was conducted inside and outside. The center also has a preschool component which will be adding a toddler option. The infant program will operate in two classrooms, Monday to Friday from 8:00am-6:00pm. The measurements are as follows: INDOORS: 953.77 = 27 infants OUTDOORS: 1,683.22 = 22 children A fire clearance was received on 2/1/22, with a total capacity of 12 infants, ages birth to 24 months was received from the Oakland Fire Department. Infant classroom is equipped with varied age appropriate materials and equipment. The infant program may possibly serve crib-age infants. There is a separate crib/nap area with 4 cribs for infants and cots available. The diaper changing counters are within arms reach of a sink. There are two sinks and a changing table available in the infant area. The staff office will serve as the isolation area for ill children. Play yard will be shared between infants and preschoolers, Applicant will provide a play yard schedule for each program to make sure infants, toddlers, and preschoolers do not commingle. The yard is fenced in all around. Two sections will be used for the outdoor play area. The lower concrete portion will need to be fully set up, before children are able to use the space. The center will be providing formula and food for infants. There is a kitchen available. Facility will utilize electronic sign in/out soon, but is still using paper sign in/out. The facility has a fully charged 3A40BC fire extinguisher, working fire alarm and carbon monoxide detector, and first aid supplies. There is a working telephone at the center.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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 - 85TH AVENUE	FACILITY NUMBER: 013423127
	VISIT DATE: 03/30/2022

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

Applicant 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.

Sandra Ruff will be considered a fully-qualified infant/preschool director. Sandra will be completing the updated 16 hours of health and safety training including child nutrition and lead poisoning and proof of completion will be sent.

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 infants will remain pending until the outdoor area is fully completed. An exit interview was conducted, and a copy of the report was provided to applicant Thao Ly.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Melissa Guirit	TELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2