013423127-6-11-2024-02-CC-THAR-D65U54-20240611151607

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423127
Report Date: 06/11/2024
Date Signed: 06/11/2024 03:16:13 PM

Document Has Been Signed on 06/11/2024 03:16 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
OAKLAND CC RO, 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:	12	CENSUS: 7	DATE:	06/11/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	LYNN PHAM		TIME COMPLETED:	03:30 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 6/11/2024 at 8:30am Licensing Program Analyst (LPA) Tasha Alexander met with Director Lynn Pham for an Unannounced Annual/random Inspection. During the inspection were seven (7) infants and four (4) staff were present. two classrooms (Room #3, play room and nap room) were toured for a health and safety inspection. The facility operates from 8:30am – 4:30pm, Monday – Friday. The facility also holds a license for preschool with a toddler option, Facility #013415387 as well. The facility has ample age appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, cleaning products, medications and hazardous materials were observed to be in inaccessible areas. There a fully stocked first-aid kit in the classroom. There are carbon monoxide detectors, smoke detectors and multiple fully charged fire extinguishers as well. All cribs are free from defects and properly maintained. All bedding is clean and properly stored. The changing station is one arm's length away from a sink, and the padding on the changing table is at least one inch thick. All medications are properly maintained, documented, and stored at the facility. There is a feeding schedule posted. The outside area is clean, free from defects with ample age-appropriate materials for the children. The play area inside is separate from older children in care. All children utilized the outside play area on a schedule, so there will be no co-mingling with older children. There is shade for the children. LPA did not observe any harmful or unattended bodies of water in or around the facility. The kitchen is clean, well maintained, and all hazards are in inaccessible areas. All children have access to clean drinking water in and outside of the classrooms. All bottles/food are properly labeled and stored .All food provided by the facility is properly stored and labeled

SUPERVISOR'S NAME: Mayla Mendoza	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 725-2831
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: OAKLAND HEAD START - 85TH AVENUE	FACILITY NUMBER: 013423127
	VISIT DATE: 06/11/2024

NARRATIVE

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The facility is operating within their licensed capacity and is in ratio in both rooms. All staff have obtained a criminal record clearance, or transfer. All required postings are made visible in the lobby of the facility and inside of the infant room. The fire/disaster drill log is complete with the last drill logged on 5/30/24. A physical census of the children was taken and cross referenced with the sign-in and out log. All children have been properly signed in by their parent or authorized representative. LPA obtained a sample of the children’s files, a sample of the staff files, and the facility files. All files were reviewed today.

Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities 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 email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed 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. END P2

LPA discussed the safe sleep regulations with Licensee 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 Licensee 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.

SUPERVISOR'S NAME: Monica Mathur	TELEPHONE: (510) 365-5196
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 725-2831
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: OAKLAND HEAD START - 85TH AVENUE	FACILITY NUMBER: 013423127
	VISIT DATE: 06/11/2024

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies today. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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.

Director 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.

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.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director Lynn Pham.

SUPERVISOR'S NAME: Monica Mathur	TELEPHONE: (510) 365-5196
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander	TELEPHONE: (510) 725-2831
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024

LIC809 (FAS) - (06/04)

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