015700514-4-28-2021-52-CC-MOTI-C2HRBR-20210428125309

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700514
Report Date: 04/28/2021
Date Signed: 04/28/2021 12:53:14 PM

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:	MISSION KIDS ACADEMY DBA GENIUS KIDS		FACILITY NUMBER:	015700514
ADMINISTRATOR:	SUBBARAYALU, GOWTHAMAN		FACILITY TYPE:	850
ADDRESS:	702 BROWN ROAD		TELEPHONE:	(408) 401-8171
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY:	44	CENSUS: 0	DATE:	04/28/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Gowthaman Subbarayalu		TIME COMPLETED:	01:02 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	An announced Pre-Licensing Inspection was conducted today 4/28/2021 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA met with Applicant Gowthaman Subbarayalu. The applicant has submitted an application for a NEW preschool license for 60 preschoolers including up to 24 toddlers in the toddler option program. The program will operate from 8:00AM - 6:30PM, Monday through Friday, in 4 classrooms. Toddler Rooms 1 & 2 will serve the toddler option program with up to 24 toddlers. A health and safety inspection was conducted inside and outside and the measurements are as follows: INDOORS: 2080.181 = 59 children OUTDOORS: 2137.52 square feet = 29 children The center has obtained an approved fire inspection clearance from the Fremont Fire Department on 04/12/2021. The preschool rooms are equipped with varied age appropriate materials and equipment. There are 4 toilets, 4 sinks available for children. The back section of Preschool Room #2 will be used as an isolation area for sick children. The facility provides am/pm snacks with children bringing lunch from home. No cleaning agents were found stored with food. The center will ask children to bring water from home and has refill stations should a child run out of water. First aid supplies are available in the center. There is a working telephone on site. Mats are being utilized for napping children. The play yard is fenced in all around. The small climbing structure is sufficiently cushioned with artificial turf. Sufficient shade was observed on the yard. Yard waiver will be issued to allow no more than 29 children out on the play yard at any time. Carbon monoxide detector was tested and is operable on today's date. The facility will utilize an electronic sign in/out system. With paper sign in/out as backup.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

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: MISSION KIDS ACADEMY DBA GENIUS KIDS	FACILITY NUMBER: 015700514
	VISIT DATE: 04/28/2021

NARRATIVE

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Individual Medical Services (IMS) policy was discussed. Facility provided LPA with current IMS plan. When any changes to IMS is made, an updated Plan of Operation 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.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and 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. Zero Tolerance policies were explained. The center was found to be clean, safe, sanitary, and in good repair.

Gowthaman Subbarayalu is a qualified Director and has current pediatric CPR/First Aid, and current mandated reporter training.

A provisional license for 58 preschool children which includes up to 24 toddlers in the toddler option program will be issued on today's date, 4/28/2021. A standard license will be issued once additional items are received.

An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

LIC809 (FAS) - (06/04)

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