010206066-2-21-2024-52-CC-JSAI-D2NVH6-20240221152638

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010206066
Report Date: 02/21/2024
Date Signed: 02/21/2024 03:26:42 PM

Document Has Been Signed on 02/21/2024 03:26 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:	RESURRECTION LUTHERAN INFANT CARE CENTER		FACILITY NUMBER:	010206066
ADMINISTRATOR:	WAZHMA MASARWEH		FACILITY TYPE:	830
ADDRESS:	7557 AMADOR VALLEY BOULEVARD		TELEPHONE:	(925) 828-2122
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY: 36	TOTAL ENROLLED CHILDREN: 36	CENSUS: 13	DATE:	02/21/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	01:36 PM
MET WITH:	Director, Wazma Masarweh		TIME COMPLETED:	03:40 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	Licensing Program Analyst (LPA) Jyoti Saini met with Director Wazhma Masarwah for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the director. In addition to the director, 13 infants, and six (6) staff members are present today. This program operates Monday-Friday, 7:30 am-5:30 pm, out of infant classroom 2, which is divided between guppies and jungle kids. The Facility was inspected indoors and outdoors today for health and safety hazards, and the following was observed: There are no bodies of water, firearms, or weapons on the premises. The Center is in good condition with proper temperature and ventilation, and is free of hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. The outdoor play area is fenced for supervision. The play structure is age-appropriate and in good condition, with sufficient cushioning underneath. The infants bring their food, and the facility provides snacks. The children's milk bottles and lunch boxes are labeled with their names. The classroom has appropriate postings. The last Emergency Drill was conducted on 01/24 and is properly logged. The Facility uses the Lillio app to sign in and sign out the children. The Center has a complete record of sign-in/out sheets by an authorized pick-up person. The facility has a working smoke ad carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available. The children's milk bottles and lunch boxes are labeled with their names. All the Children's records reviewed were complete. All children have a record of emergency identification information on file. LPA observed the Individual Infant Sleep Plan (LIC9227) for all infants under 12 months. All the infant's files have infant needs and service plans. LPA reviewed the sleep record log for 15-minute checks. The classroom has a diaper-changing table, sleeping mats, and cubbies with children's names. All staff has a criminal record clearance on file. The site Director has a current Pediatric First Aid/CPR certificate. The opening and closing teachers have current Pediatric First Aid/CPR certificates on the file. The facility roster was reviewed, and a copy was obtained. See next page...

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: RESURRECTION LUTHERAN INFANT CARE CENTER	FACILITY NUMBER: 010206066
	VISIT DATE: 02/21/2024

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
26
27
28
29
30
31
32

Criminal Record Clearance -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.

Lead Testing – CCC COMPLETED TESTING

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.
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
Incidental Medical Services (IMS)
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records.
For IMS information see PIN 22-02-CCP. 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/.
MyChildCarePlan.org
Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

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.

No deficiency is 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, Wazma Masarwah.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2