015700580-8-23-2023-52-CC-EWOS-CUYTX8-20230823150644

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700580
Report Date: 08/23/2023
Date Signed: 08/23/2023 03:06:50 PM

Document Has Been Signed on 08/23/2023 03:06 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:	HUSD - BURBANK PRESCHOOL		FACILITY NUMBER:	015700580
ADMINISTRATOR:	RUBIO, ANN KRISTINNE		FACILITY TYPE:	850
ADDRESS:	222 BURBANK STREET		TELEPHONE:	(510) 723-3805
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 13	DATE:	08/23/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Ann Kristinne Rubio		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 August 23, 2023 at 1:00 PM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced 1 Year Required Inspection and met with the facility representative, Ann Kristinne Rubio. LPA disclosed the purpose of the inspection and was granted entry into the facility by the facility representative. There were 13 children present during this inspection and two (2) additional staff members. The facility is located on the campus of Burbank Elementary School in Room 7. The hours of operation are 8:30 AM to 11:30 AM for morning session, and 12:30 PM to 3:30 PM for afternoon session. LPA checked the facility RECORDS and they show all individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. LPA conducted a census of the children and the census matches the children signed in on the sign in sheet. LPA reviewed two (2) children's files around 1:30 PM. Staff files are maintained and stored in the Hayward School Districts Human Resource Office and all licensing requirements for personnel are met as a condition of employment with the school district. All children files contains Personal Rights, Medical Consent forms and Identification and Emergency Information. LPA reviewed the facility and personnel roster and obtained copies. The one classroom was inspected around 1:30 PM and teacher child ratio was observed. There are adequate play and learning materials available. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is next to the front door, away from other children in care. The center has wired smoke detectors, a working carbon monoxide detector, working telephone, first aide kits, and one (1) fully charged 3A40BC fire extinguisher which meets standards established by the State Fire Marshal. Disaster drills are being conducted at least once every 6 months in conjunction with the Hayward Unified School District schedule. All required documents are posted in a public accessible area. See 809-C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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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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: HUSD - BURBANK PRESCHOOL	FACILITY NUMBER: 015700580
	VISIT DATE: 08/23/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, an updated 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) 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/.

This facility provides lunch for children in care and the center sends the food menu out through class Dojo. Food is protected from contamination and, per staff, contaminated food is discarded immediately. All storage containers for solid waste have tight fitting covers that are in good repair.

LPA Woods inspected the outdoor climbing structure that has a slide with cushioning material underneath to absorb children falls. The outdoor area is fully fenced and the playground equipment observe to be safe and free of hazards. There center has multiple trees that provides shade to children while at play and per staff the children brings their water bottles and cups to the playground to stay hydrated. The play equipment is age appropriate and in good repair.

The staff's bathroom is separate from the children's bathroom and all of the sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets and the paper towels and soap are available to the children.

California Law requires Child Care Centers licensees 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 electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

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.

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

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: HUSD - BURBANK PRESCHOOL	FACILITY NUMBER: 015700580
	VISIT DATE: 08/23/2023

NARRATIVE

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The 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.

The facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

There are no 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 facility representative Ann Kristinne Rubio.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2023

LIC809 (FAS) - (06/04)

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