073408875-5-8-2023-02-CC-CWAS-CRN5WR-20230508201930

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408875
Report Date: 05/08/2023
Date Signed: 05/08/2023 08:22:50 PM

Document Has Been Signed on 05/08/2023 08:22 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	CALVARY CHRISTIAN PRESCHOOL		FACILITY NUMBER:	073408875
ADMINISTRATOR:	MULLENS, AMY		FACILITY TYPE:	830
ADDRESS:	3425 CONCORD BLVD		TELEPHONE:	(925) 682-6728
CITY:	CONCORD	STATE: CA	ZIP CODE:	94519
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 6	CENSUS: 6	DATE:	05/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Amy Mullens		TIME COMPLETED:	04:00 PM

NARRATIVE

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On 05/08/2023 at 2:20 PM, Licensing Program Analysts (LPA) Christina Watts conducted an unannounced Annual inspection at Calvary Christian School - Infant Program. Facility is located on Lifepoint Church and Calvery Christian Elementary and High School. LPA met with Director Amy Mullens, and explained the purpose of today's inspection. During today's inspection there were 6 infants and 1 teacher and 1 aide. All staff in the facility are Criminal Record Cleared. Facility's operating days and hours are Monday to Friday from 7:00 am - 6:00 pm in 1 Room. .

Indoor Space: physical plant was inspected and toured with Director. Infant room is Infants were engaged in various activities under the visual supervision of the teacher and an aide. Room, restrooms, and in use areas were inspected. Food and feeding bottles were labeled and stored safely. Food storage areas were sanitary, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair. Napping area had cribs and was cordoned off from the activity area by dividers. The infant changing table has raised sides that are at least 3 inches in height, has a vinyl changing pad that is at least 1 inch thick and in good condition. Napping equipment is appropriate. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Cabinets, drawers, and rooms used for storage were locked. Floors were clean and free from tripping hazard. LPA observed a working fire extinguisher, smoke and carbon monoxide detectors. Log shows that the last Fire Drill was conducted on April 10, 2023. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles. Facility’s License, Parents’ Rights Poster PUB 393, Personal Rights, and Activity Schedules. Director stated parents bring the children snacks and lunches.

Outdoor Space: Outdoor activity space was inspected and observed to be safe. The play equipment is age appropriate and maintained in good condition and free of hazards. There were no bodies of water observed.

*CON'T ON PAGE 2*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

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 05/08/2023 08:22 PM - It Cannot Be Edited

Created By: Christina Watts On 05/08/2023 at 05:16 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CALVARY CHRISTIAN PRESCHOOL	FACILITY NUMBER: 073408875
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101419.3(a)

Modifications to Infant Needs and Services Plan

(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above when 5 infants Needs and Services forms were not updated which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/15/2023
	Plan of Correction
1 2 3 4	Complete Needs and Services plan and submit plan to licensing. Director will also submit a written statement on how Director will maintain Needs and Services plan for infants.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Sherelle Johnson

LICENSING EVALUATOR NAME:

Christina Watts

LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CALVARY CHRISTIAN PRESCHOOL	FACILITY NUMBER: 073408875
	VISIT DATE: 05/08/2023

NARRATIVE

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*PAGE 3*

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.

LPA Christina Watts informed Director, Amy Mullens that this report dated 05/08/2023 documents a Type B citation. Type B citation(s) are a potential risk(s) to the health, safety, or personal rights of children in care. *SEE LIC 809D FOR DEFICIENCIES.*

Exit interview conducted and report was reviewed with Director, Amy Mullens. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

Page: 3 of 6

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CALVARY CHRISTIAN PRESCHOOL	FACILITY NUMBER: 073408875
	VISIT DATE: 05/08/2023

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*PAGE 2*

File Review: Sign in and out procedures and logs were reviewed. A sampling of Infant and Staff files was taken for review. LPA reviewed the Needs and Services Plan for all infants and only one infant had an up to date Needs and Service Plan. Director was reminded the importance and requirement of maintaining Needs and Services plans for infants every 90 days. Director stated she will update Needs and Services plan and will submit a copy to licensing. Reviewed Individual Safe Sleep Plan LIC9227 for infants. Director stated she logs infants sleep however does not keep the log. LPA informed Director that Infant Sleep is required to be log and kept at the facility. Director stated that she will keep a copy of the log and give a copy of the log to the parents. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. A copy of Children Roster and Personnel Report was reviewed and obtained.

Page 2

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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. *CON'T ON PAGE 3*

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC809 (FAS) - (06/04)

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