376701230-6-29-2021-20-CC-MHOD-C4FRZU-20210629132831

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376701230
Report Date: 06/29/2021
Date Signed: 06/29/2021 01:29:37 PM

Document Has Been Signed on 06/29/2021 01:29 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	ALPINE CHILDREN'S ACADEMY		FACILITY NUMBER:	376701230
ADMINISTRATOR:	STEPHANIE FREEMAN		FACILITY TYPE:	830
ADDRESS:	2403 ALPINE BOULEVARD		TELEPHONE:	(619) 445-5462
CITY:	ALPINE	STATE: CA	ZIP CODE:	91901
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 0	CENSUS: 3	DATE:	06/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Stephanie Freeman, Director		TIME COMPLETED:	10:00 AM

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 06/29/2021, at 8:45 a.m., at Licensing Program Analyst (LPA) Michelle Hood, conducting an unannounced Annual Inspection for the infant license and met with Director, Stephanie Freeman. LPA disclosed the purpose of the inspection and toured the facility indoors and outdoors. This is a full day program. The facility operates MOnday - Friday 6:30 a.m. - 6:00 p.m. There is currently one (1) infant classroom in operation. There were two (2) staff members present with three (3) infants under the age of two. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Areas around the infant outdoor play equipment have cushioning material to absorb falls. The facility is free of flies, inspects and rodents. There is a working carbon monoxide detector. A review of staff records on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Upon notification from the Department, the director will comply and act immediately to terminate the employment, remove from the facility or bar from entering the facility for any person it deemed necessary while the Department considers granting or denying an exemption.

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ALPINE CHILDREN'S ACADEMY	FACILITY NUMBER: 376701230
	VISIT DATE: 06/29/2021

NARRATIVE

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Capacity and limitations as specified on the license are being maintained. At least one (1) person trained in CPR and Pediatric First Aid is present when children are present at the facility or at off-site activities. The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher always. There is a ratio of one teacher supervising no more than four infants in care. LPA reviewed a sample of children's files and observed files were complete with contact information for authorized representative for the child, medical assessment, individual feeding plan, and Infant Needs and Services Plan. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Staff records contain documentation of meeting qualification requirements. Menus are posted at least one week in advance where authorized representative can view menu. The facility has enough age appropriate furniture, and equipment including cots, and cribs. There is indoor and outdoor activity space.

Each crib or cot is occupied by only one infant at a time and cribs are kept free from all loose articles including blankets and pillows and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. Staff physically checks on sleeping infants every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Documentation for infants up to 12 months includes sleeping position if it is other than on their back. Individual Infant Sleeping Plan is completed and in the file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Staff-infant ratio requirements are being met while infants are sleeping.

This facility does not provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual – Regulation Interpretations and Proceduces for Child Care Centers Sections 101173 and 101226. 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.

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: ALPINE CHILDREN'S ACADEMY	FACILITY NUMBER: 376701230
	VISIT DATE: 06/29/2021

NARRATIVE

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LPA and Director discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, California Megan's Law (www.meganslaw.ca.gov), Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, no deficiencies are cited. An exit interview was conducted with Director. Director was provided a copy of their appeals rights (LIC 9058).

SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC809 (FAS) - (06/04)

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