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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700574
Report Date: 08/31/2023
Date Signed: 08/31/2023 03:14:33 PM

Document Has Been Signed on 08/31/2023 03:14 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:TOTS UNIVERSITY PRESCHOOLFACILITY NUMBER:
015700574
ADMINISTRATOR:BOGA, PRIYANKAFACILITY TYPE:
850
ADDRESS:7890 OXBOW LANETELEPHONE:
(225) 368-6002
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 24DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:director, Priyanka BogaTIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jyoti Saini met with teacher in charge, Cathy Mendez for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Staff. The facility owner/director arrived during the inspection. In addition to the director, there are 26 children, two cleared and associated staff members and one volunteer staff present today. The facility operates Monday - Friday from 8:00 AM to 6:00 PM. 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. There are separate bathrooms for the children and staff. The bathrooms appear to be safe, sanitary, and free of any hazardous items. There is drinking water readily available for children using water bottles brought from home, and the facility refills the water bottles using a water fountain.The facility provides lunch and snacks. The classroom has appropriate postings. The last Emergency Drill was conducted on 08/11/2023 and is properly logged. LPA reviewed storage of food and reminded director that all food must be in original packaging or labeled with expiration date.

LPA reviewed sign-in and out sheet. The center does not have complete record of sign in and out sheet. There is a working fire alarm system in the facility. The facility has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available.

LPA reviewed five (5) children files. All children have a record of emergency identification information on file. Staff records reviewed were complete. All staff has a criminal record clearance on file. The site Director has a current Pediatric First Aid/CPR certificate on file. A copy of the facility personnel roster and children’s roster were available for review and copy was obtained.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: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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 7
Document Has Been Signed on 08/31/2023 03:14 PM - It Cannot Be Edited


Created By: Jyoti Saini On 08/31/2023 at 02:09 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: TOTS UNIVERSITY PRESCHOOL
FACILITY NUMBER: 015700574

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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. Volunteer staff does not have proof of MMR and pertussis which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/15/2023
Plan of Correction
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Site director shall collect proof of immunization records and place them in the personnel file and also shall submit the proof to CCLD.
Type B
Section Cited
CCR
101229.1(d)
Sign In and Sign Out
(d) The sign-in and sign-out sheets with the signatures required by this section and by Section 101226.1 shall be kept for one month and shall be available at the center for review by the Department.

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. During the inspection, LPA observed that out of 26 children only 20 children were signed in, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/04/2023
Plan of Correction
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Director shall implement a sign in/out procedure and sublit a plan of correction to Community Care licensing division
( CCLD) by due date.
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: 08/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023


LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 08/31/2023 03:14 PM - It Cannot Be Edited


Created By: Jyoti Saini On 08/31/2023 at 02:09 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: TOTS UNIVERSITY PRESCHOOL
FACILITY NUMBER: 015700574

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/31/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101227(a)(19)
Food Service
(19) All food shall be protected against contamination. Contaminated food shall be discarded immediately.

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. During the inspection, LPA observed an expired bread loaves in the refrigerator which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/04/2023
Plan of Correction
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Site Director immediately cleared the expired foods and placed them in the trash bins.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 08/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023


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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: TOTS UNIVERSITY PRESCHOOL
FACILITY NUMBER: 015700574
VISIT DATE: 08/31/2023
NARRATIVE
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During inspection,

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.

Incidental Medical Services (IMS) policy was discussed. This facility not provide IMS (Incidental Medical Services) to children currently. If any IMS is provided, a Plan for Providing IMS 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

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.

see the attached (LIC809-D) for the deficiencies cited today.

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

Exit interview conducted and report was reviewed with the director, Priyanka Boga.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC809 (FAS) - (06/04)
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