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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700573
Report Date: 08/01/2023
Date Signed: 08/01/2023 02:47:43 PM

Document Has Been Signed on 08/01/2023 02:47 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:QUARRY LANE SCHOOL, THEFACILITY NUMBER:
015700573
ADMINISTRATOR:AGUILAR, CLAUDIAFACILITY TYPE:
850
ADDRESS:5600 SCARLETT DRIVETELEPHONE:
(925) 846-9400
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 300TOTAL ENROLLED CHILDREN: 300CENSUS: 66DATE:
08/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:director, Claudia AquilarTIME COMPLETED:
03:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jyoti Saini met with facility representative, Claudia Aguilar for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the director. Present during the inspection director and 8 staff members supervising 66 children. The facility currently operating Monday – Friday,7:00am to 6:00pm in Room #1 through Room #15, an Art Studio, Music/Library, STEM lab and MPR. The facility was inspected indoor and outdoor today for health and safety hazards and the following was observed.

There are no bodies of water, firearms, or weapons on the premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. A first aid kit and a first aid backpack are available. The outdoor play area is fenced for supervision. The play structure is age-appropriate and in good condition with sufficient cushioning underneath. The program provides daily snacks and facility requires families to provide lunch. LPA reviewed storage of food and reminded director that all food must be in original packaging or labeled with expiration date. The classroom has appropriate postings. The last Emergency Drill was conducted on 12/14/2022 and is properly logged. Medications are stored on the high shelves which is inaccessible to children in care. The menu is posted in a visible location and is dated for the entire month. LPA did not observe any dangerous items accessible today, including medications, poisons, disinfectants, or cleaning supplies, that could be dangerous to the children in care. All solid waste containers have tight fitting covers on and appear to be in good repair. LPA reviewed sign-in and out sheet.The facility uses electronic sign in sign out -Tadpole app. The center has a complete record of sign-in/out sheets by an authorized pick-up person. There is a working fire alarm system. The facility has a working smoke and hardwired carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available. The facility acknowledged that they are aware of carbon monoxide testing requirements.

The center roster was reviewed, and a copy was obtained. A review of 12 children's files and 9 staff files were completed. All children have a record of emergency identification information and immunization record on file. All staff has a criminal record clearance on file. The opening and closing staff have a current Pediatric First Aid/CPR certificate on file.

see next page...

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
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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Document Has Been Signed on 08/01/2023 02:47 PM - It Cannot Be Edited


Created By: Jyoti Saini On 08/01/2023 at 01:00 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: QUARRY LANE SCHOOL, THE
FACILITY NUMBER: 015700573

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. The last fire/earthquake drill was condutced on 12/14/2022 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/04/2023
Plan of Correction
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The facility shall conduct a fire drill and submit the proof to the CCLD. Going forward, the facility shall conduct a fire or earthquake drill at least once each six months.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as three (3) out of nine (9) staff did not have proof of MMR which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2023
Plan of Correction
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Facility representative shalll have staff provide proof of MMR. Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023


LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 08/01/2023 02:47 PM - It Cannot Be Edited


Created By: Jyoti Saini On 08/01/2023 at 01:00 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: QUARRY LANE SCHOOL, THE
FACILITY NUMBER: 015700573

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(2)
Personnel Requirements
(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above as four (4) staff members does not have proof of a health screening nor TB clearance in their files, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/22/2023
Plan of Correction
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Licensee shall submit a copy of health screening and TB clearance to the department by due date of 8/22/2023.
Type B
Section Cited
CCR
101226(e)(3)(A)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation,record review the licensee did not comply with the section cited above. C12's epipen were found to be expired, which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 08/02/2023
Plan of Correction
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The director shall return the expired EpiPen to the parents and obtain un-expired EpiPen. All Incidental Medical Plans should be followed and medications checked on a regular basis to ensure that no medications become expired.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023


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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: QUARRY LANE SCHOOL, THE
FACILITY NUMBER: 015700573
VISIT DATE: 08/01/2023
NARRATIVE
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During inspection,

Criminal Record Clearance -

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.

Incidental Medical Services (IMS)


This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records.
For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.
MyChildCarePlan.org
Licensee [or facility representative] was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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 attached four(4) type B deficiencies were cited today, and three (3) technical violations were given. 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, Claudia Aquilar.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC809 (FAS) - (06/04)
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