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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700580
Report Date: 08/30/2024
Date Signed: 08/30/2024 02:15:45 PM

Document Has Been Signed on 08/30/2024 02:15 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 PRESCHOOLFACILITY NUMBER:
015700580
ADMINISTRATOR/
DIRECTOR:		RUBIO, ANN KRISTINNEFACILITY TYPE:
850
ADDRESS:222 BURBANK STREETTELEPHONE:
(510) 723-3805
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 13DATE:
08/30/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Jackie Amo-MenshTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On August 30, 2024 at 12:10 PM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced Annual Random Inspection and met with the facility representative Jackie Amo-Mensh. 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 one (1) additional staff member. The facility is located on the campus of Burbank Elementary School in Room 7. The hours of operation are 8:10 AM to 11:10 AM for morning session, and 11:40 AM to 2:40 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 three (3) children's files around 12:30 PM. All children files contains Personal Rights, Medical Consent forms and Identification and Emergency Information. 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. LPA reviewed the facility roster. and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate.

The one (1) classroom was inspected around 12:20 PM and teacher child ratio was observed. There are adequate play and learning materials available. The floors are well maintained and the furniture is the correct size for preschool children. The classrooms equipment is in good repair and the preschool room temperature is adequate. There is proper individual storage space for each child and the cubbies have their names and pictures posted on the shelves. The isolation area for sick children is the library area, away from other children in care.

The center has wired smoke and carbon monoxides detectors, a working telephone, and a fully charged 3A40BC fire extinguisher, which meets standards established by the State Fire Marshal hanging on the classroom wall in a glass case. 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: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2024
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: 08/30/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When 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: https://www.ada.gov/resources/child-care-centers/

This facility provides lunch for children in care and they have weekly menus posted on the parent board at the facility. The center also sends the food menu out through class Dojo. LPA observed an area where they have a mini refrigerator this area is clean and free of evidence of rodents. Low fat milk is being served at the center and food is protected from contamination and, per staff, contaminated food is discarded immediately. LPA reminded the facility representative that all persons engaged in food preparation and service shall observe personal hygiene and food service sanitation practices to protect food from contamination. All storage containers for solid waste have tight fitting covers that are in good repair.

LPA’s observations during the visit

At 12:10 PM, LPA observed the children having lunch at two tables designated for eating. There was one staff person at the table helping the children with their food. The other staff person was gathering information and files for me to evaluate during the inspection. After lunch the staff cleared the food off the table and prepared the tables for the afternoon activities. The lead teacher gathered all of the children on the carpet for story time and the children participated in the learning. Next the lead teacher put on some educational music on and the children danced, jumped, and clapped to the rhythm. Around 1:00 PM the children had open play and explored the classrooms different learning areas while being supervised by the staff.


At 1:05 PM, LPA was told by the facility representative that the staff bathroom is separated from the children's bathroom and that the staff's bathroom was out in the schools hallway. LPA checked the children's bathroom around 1:10 PM to make sure that the toilets flushed and that the water faucet(s) hot water was not hot enough to burn children in care and it passed. All of sinks and faucets are in safe and sanitary operating condition and paper towels and soap are available to children. LPA also flushed the toilet in the children's bathroom to make sure that it didn't overflow and the toilet worked just fine.

The outdoor play area has a large play structure that's anchored to the ground. LPA Woods inspected the outdoor climbing structure and observed that it has 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. The center has multiple trees that provides shade to children while at play and per staff water bottles are brought to the playground to keep the children hydrated. There's an additional gate with a lock to prevent children access to equipment on the playground next to the exit gate. The play equipment is age appropriate and in good repair.

See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
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: 08/30/2024
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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. The facility representative was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

Lead Testing – Child Care Centers (CCC) CCC COMPLETED TESTING AND NO LEAD EXCEEDANCES: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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 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 Jackie Amo-Mensh.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
LIC809 (FAS) - (06/04)
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