015700575-7-7-2022-52-CC-MOTI-CG4SUZ-20220707141159

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700575
Report Date: 07/07/2022
Date Signed: 07/07/2022 02:12:11 PM

Document Has Been Signed on 07/07/2022 02:12 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	HUSD CHILD DEV. PROGRAM - MUIR		FACILITY NUMBER:	015700575
ADMINISTRATOR:	RUIZ, MARIA		FACILITY TYPE:	850
ADDRESS:	2424 EAST AVENUE		TELEPHONE:	(510) 723-3815
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 0	DATE:	07/07/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Kristina Adams		TIME COMPLETED:	02:30 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	A Prelicensing Visit was conducted today 07/07/2022 by Licensing Program Analysts (LPA) Melanie Otsuji. LPA met with Director of Early Learning, Kristina Adams. The applicant has submitted an application for a Relocation from 24823 Soto Road, Hayward to 2424 East Avenue, Hayward. Program is located on the campus of East Avenue Elementary School in Room 26. The program will operate from 8:00AM - 4:00PM in one classroom with an AM/PM session. Facility is also changing their name from HUSD Child Development Program - Muir to HUSD - East Avenue Preschool. This is a TITLE V facility. A health and safety inspection was conducted inside and outside and the measurements are as follows: INDOORS: 1153.72 square feet = 32 children OUTDOORS: 7174.24 square feet = 95 children The preschool room is equipped with varied age appropriate materials and equipment. There are 5 toilets and 4 sinks available for children. There is an isolation tent set up on campus for ill children and children will utilize the nurses office toilet if needed. There is a food prep area. There is 1 play yard. Kinder playground is fenced in all around. Building overhang provide sufficient shade in the play yard The center has functioning drinking fountains inside, jugs and cups, as well as water bottles for indoor and outdoor activities. Hayward Unified School District will provide breakfast to AM class and lunch to PM class. No cleaning agents were found stored with food. First aid supplies are available in the center. There is a working telephone on site. Carbon monoxide is available.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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: HUSD CHILD DEV. PROGRAM - MUIR	FACILITY NUMBER: 015700575
	VISIT DATE: 07/07/2022

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes 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.

Maria Ruiz is a fully-qualified preschool director and has completed 16 hours of health and safety training including pediatric CPR and First Aid.

Mandated reporter and appeal rights, 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.

A license for 24 children will be issued effective today's date, 7/7/2022.

An exit interview was conducted with Director of Early Learning, Kristina Adams.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

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