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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206131
Report Date: 06/09/2022
Date Signed: 06/09/2022 05:26:32 PM

Document Has Been Signed on 06/09/2022 05:26 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:OUSD - HINTIL KUU CAFACILITY NUMBER:
010206131
ADMINISTRATOR:JONES, CAROLINEFACILITY TYPE:
850
ADDRESS:11850 CAMPUS DRIVETELEPHONE:
(510) 879-0840
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 12DATE:
06/09/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Dolores JeffTIME COMPLETED:
05:30 PM
NARRATIVE
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On 6/9/22 at 9:05AM, Licensing Program Analyst (LPA) Catherine Fernandes and Licensing Program Manager (LPM) Loretta Dyson arrived at the facility for an unannounced 1 year continued required inspection. LPA and LPM met with Head Teacher Dolores Jeff. There were 12 children in care and one additional staff member. The teacher/ child ratio was being met today. The center and playground were inspected under Title 5 regulations to conduct a health and safety check. The facility operates Monday through Friday 8:30AM to 3:00PM.
The preschool operates out of the Carl B. Munck Elementary school and is licensed to use two classrooms. However the center is only using one of the classrooms. The room floors, surfaces, furniture and equipment appear to be safe, sanitary and in good repair. The heating and lighting and ventilation is adequate. There is one sink, two toilets and one urinal for available for the children to use, which is sanitary and in working conditions. There is a separate bathroom for staff. The activities and toys appear to be age appropriate for the children in care. The outside play area is right outside the classroom and is a smaller portion of the yard due to construction to the play structure. There is a shaded area and age appropriate toys. There are supplies available for the children to wash and dry their hands. The children in care have individuals water bottles for drinking and the center provides prepackaged lunches to the children that are prepared at another site. The center is providing 1% milk to children in care. The kitchen area was maintained. Due to COVID 19 the center is using electronic sign in and out. LPA did not observe any bodies of water, free standing water, cleaning supplies, or toxic items accessible to children during todays inspection. The children have their own boxes to store their belongings.
Disaster drills are being conducted at least once every 6 months, the last drill was recorded in March 2022. The center is equipped with a fully stocked first aid kit, working telephone, carbon monoxide detector, 3A40BC fire extinguishers and smoke detectors. The fire system is hardwired. A review of 5 children records and two staff files were reviewed.

Report continued on 809C
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 06/09/2022 05:26 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 06/09/2022 at 01:32 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: OUSD - HINTIL KUU CA
FACILITY NUMBER: 010206131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the center did not comply with the section cited above in two of the two files reviewed, which poses a safety rights risk to persons in care.
POC Due Date: 06/30/2022
Plan of Correction
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The center will complete the correct mandated reporter training and submit proof by POC date.
Type B
Section Cited
CCR
101227(6)
Food Services Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the center did not comply with the section cited above, which poses a potential health risk to persons in care.
POC Due Date: 06/30/2022
Plan of Correction
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The center will come up with a plan to ensure the menus are posted and current by POC date.
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:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022


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Document Has Been Signed on 06/09/2022 05:26 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 06/09/2022 at 01:40 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: OUSD - HINTIL KUU CA
FACILITY NUMBER: 010206131

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/09/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101237(A)
Alterations to Existing Buildings or New Facilities
(a) Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s).



This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the center did not comply with the section cited above the playground is under construction, which is a potential health and safety risk to persons in care.
POC Due Date: 06/30/2022
Plan of Correction
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The center will review the regulations and submit a report stating the schedule times for construction, the duration and how the center will ensure the children's daily routines are not interrupted. The center also needs to include a plan to ensure that the construction workers do not have access to the children in care by POC date.
Type B
Section Cited
CCR
101212(c)
Reporting Requirements- The licensee shall notify the Department in writing of his/her intent prior to making any structural changes that reduce the total amount of indoor or outdoor activity space. Such structural changes shall include, but not be limited to, room additions.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and interviews, the center did not comply with the section cited above one of the classrooms is being used by another program which poses a potential personal rights risk to persons in care.
POC Due Date: 06/30/2022
Plan of Correction
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The center will review reporting requirement regulations and come up a plan as to what the center would like to do moving forward by POC date.
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:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2022


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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: OUSD - HINTIL KUU CA
FACILITY NUMBER: 010206131
VISIT DATE: 06/09/2022
NARRATIVE
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The following was observed during the inspection:
At 9:15AM LPA and LPM observed construction being done to the outdoor play structure, which was fenced off to enclose the area. Licensing was unaware of the construction.

LPA and LPM observed another program that has relocated to the center causing Hintil day care to only use one of the two classrooms that are licensed. The center failed to inform licensing that another center was relocating at the site and that one of the two classrooms were not going to be used.

At 11:17AM when reviewing two of the two staff files, it was observed that the center has not completed the correct Mandated Reporter training for child care providers.

During the walk through LPA Fernandes observed a menu that was posted from April 18,2022 to May 6, 2022.

Incidental Medical Services (IMS) policy was discussed. 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 teacher Dolores confirmed that as of right now they are not providing IMS.

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.

Report continued on 809C
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
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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: OUSD - HINTIL KUU CA
FACILITY NUMBER: 010206131
VISIT DATE: 06/09/2022
NARRATIVE
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The center 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.



The following copies are needed for the facility file:
LIC500 Updated Personnel report
LIC308 Updated Designation of Facility Responsible
LIC610 Disaster Plan
All required documents needs to be moved to the main classroom for public review.
Copies of the roster

Due to center hours LPA and LPM conducted the exit interview with Sharon Travers
A notice of site visit was given and must remain posted for 30 days
Exit interview conducted and report and appeal rights provided
Notice of site visit was provided and needs to be posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022
LIC809 (FAS) - (06/04)
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