Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407392
Report Date: 01/27/2017
Date Signed: 01/27/2017 01:50:12 PM

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:PUSD - HIGHLANDS PRESCHOOLFACILITY NUMBER:
073407392
ADMINISTRATOR:HOLMAN, LONGRELFACILITY TYPE:
850
ADDRESS:4141 HARBOR STTELEPHONE:
(925) 473-2440
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:24CENSUS: 20DATE:
01/27/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:TIME COMPLETED:
01:45 PM
NARRATIVE
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(3)LPA Tasha Alexander met today with lead Teacher Laura Serrato for an ANNUAL/RANDOM visit. LPA toured the facility and play yard for a health and safety inspection. This is a Title V program. Personnel files were reviewed. The teacher/child ratio was being met. Children's files were reviewed. The classroom(s) and play yard were age appropriate and in good repair. Bathroom is clean and in working order. Lunches and snacks are provided by the facility and consumed in the elementary school's cafeteria. There is an adequate variety and quantity of food available; menu is not posted in the classroom today. The sign in and out logs were reviewed. All posting requirements are being met. Outdoor play area was free of hazards and provided a shaded area for the children and access to drinking water. Medications, when dispensed, are stored in the classroom cabinet in a locked box. There is a working telephone at the facility. Opening and closing staff have current CPR and 1st Aid training which expires on 3/2/2018 respectively.

Applicant was instructed on the law establishing a $100 fine per day for adults who are providing care who do not have fingerprint clearances.

Effective September 1, 2016, a person may not work or volunteer at a child care center or family child care home unless he or she has been immunized against pertussis, measles and influenza or has an exemption.

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

The attached type B deficiencies are cited today and must be corrected by the due date. An exit interview was conducted. This report must be available for public review for 3 years. A notice of site visit was posted.


SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2017
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PUSD - HIGHLANDS PRESCHOOL
FACILITY NUMBER: 073407392
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2017
Section Cited
H&S 1597.622
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ยง1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions
(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

TODAY STAFF DOES NOT HAVE IMMUNIZTION RECORDS IN FILE.
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LICENSEE WILL HAVE STAFF OBTAIN THEIR IMMUNIZATION RECORDS. LICENSEE WILL SUBMIT COPIES OF RECORDS TO COMMUNITY CARE LICENSING BY 2/27/17. RECORDS MUST SHOW THAT THE INDIVIDUAL HAS BEEN IMMUNIZED AGAINST PERTUSSIS, MEASLES AND INFLUENZA.
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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: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Tasha Hackett-AlexanderTELEPHONE: (510) 622-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2017
LIC809 (FAS) - (06/04)
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