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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206151
Report Date: 04/07/2022
Date Signed: 04/07/2022 01:35:50 PM

Document Has Been Signed on 04/07/2022 01:35 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 - JEFFERSONFACILITY NUMBER:
010206151
ADMINISTRATOR:GRIFFIN, ANASTASIAFACILITY TYPE:
850
ADDRESS:1975 - 40TH AVENUETELEPHONE:
(510) 436-3700
CITY:OAKLANDSTATE: CAZIP CODE:
94601
CAPACITY: 48TOTAL ENROLLED CHILDREN: 15CENSUS: 10DATE:
04/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Anastasia GriffinTIME COMPLETED:
01:45 PM
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On 04/07/2022 at 8:30am Licensing Program Analyst (LPA) Diana Campos arrived at the facility for an unannounced Annual Required inspection. This is a Title 5 facility. LPA met with on-site supervisor/head teacher, Anastasia Griffin, and toured all areas used by day care children for a health and safety inspection. Present during today's inspection were 3 facility staff and 10 preschool age children in care. The facility is within ratio and capacity. Per facility staff, there are no firearms stored on the premises. Meals and snacks are delivered from school district. There are menus posted and available for review. Counter tops and surfaces are free of toxins/hazardous items. There is centralized smoke/fire alarm inspected by city fire and a working carbon monoxide detector. There are multiple fully charged fire extinguishers. All required postings are present. Bathroom faucets and toilets are in working order. The facility has lighting and heating for safety and comfort. The outdoor play area is fully fenced and separate to the school age children play area. There are no pools or other accessible bodies of water and climbing equipment is securely anchored with cushioning under/around the equipment. Drinking water is available indoors and outdoors. There are individual/separate storage cubbies for children's belongings as well as sleeping cots and linens. A review of cleaning and food supply storage areas was made. First Aid supplies were inventoried. The facility, children and staff records were reviewed including admissions agreements, parents' rights forms, teacher qualifications and sign In/sign out records. Staff certification in CPR and FIRST AID is current and valid for site supervisor/Head Teacher and expires 01/08/2024.
At 10:00am a sample of children's files were brought over and reviewed and were found to be complete.
This facility currently does not provide Incidental Medical Services-IMS. 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
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2022
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: OUSD - JEFFERSON
FACILITY NUMBER: 010206151
VISIT DATE: 04/07/2022
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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

On-Site Supervisor/Head Teacher 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.

LPA discussed the safe sleep regulations with Head Teacher 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 Head Teacher 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.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with On-Site Supervisor/Head Teacher Anastasia Griffin.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC809 (FAS) - (06/04)
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