010206151-3-30-2023-02-CC-ACUY-CQERBK-20230330125252

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010206151
Report Date: 03/30/2023
Date Signed: 03/30/2023 12:53:04 PM

Document Has Been Signed on 03/30/2023 12:53 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 - JEFFERSON		FACILITY NUMBER:	010206151
ADMINISTRATOR:	GRIFFIN, ANASTASIA		FACILITY TYPE:	850
ADDRESS:	1975 - 40TH AVENUE		TELEPHONE:	(510) 436-3700
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94601
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 55	CENSUS: 40	DATE:	03/30/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Anastasia Griffin		TIME COMPLETED:	01:15 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	On 03/30/2023 at 11:30 AM Licensing Program Analyst (LPA), A. Curry conducted an unannounced random inspection. LPA met with designated head teacher, Anastasia Griffen. This is a preschool age program licensed for 48 children which operates Monday – Friday. Hours of operation in Room 1 are from 8:00 AM- 5:00 PM and room 2 are from 8:30AM - 11:30AM and 12:00PM- 3:00PM. Per the head teacher there are 55 children enrolled. LPA A. Curry began facility tour with Director. All areas identified on the facility sketch were inspected. In room 1 LPA observed 24 children with 4 staff. In room 2 LPA observed 16 children with 2 staff and 5 parent volunteers. Teacher-child ratios were observed to be in accordance with Title 5 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times. LPA observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. All indoor classrooms were inspected to ensure that the floors have a surface that is safe and clean. All toilets facilities are in safe and sanitary operating conditions. SInk 2 in room 2 and the kitchen food prep sink exceeded the acceptable amount of lead allowed in a child care facility (See 809D). Staff indicated the sink in the kitchen is used to prepare food. Both sinks were made inoperable during today's visit. At this time, the office is used as an isolation area. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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: 03/30/2023

NARRATIVE

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Snack menus were reviewed. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination. There is drinking water available in all indoor classrooms and individual drinking containers are taken outdoors. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The licensee takes measures to keep the facility free of flies, other insects and rodents.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition and is free of hazards. Areas around and/or under climbing equipment have cushioning material to absorb a fall. LPA did not observe any bodies of water during this visit. Head teacher states there are no weapons or firearms on the premises.

Sign in and out sheets were reviewed. Staff and children records were reviewed. Verification of CPR/First Aid and health preventative practices documentation was reviewed.

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

Licensee 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.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights were given, and report was reviewed with the head teacher Anastasia Griffin.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/30/2023 12:53 PM - It Cannot Be Edited

Created By: Ashley Curry On 03/30/2023 at 12:14 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 - JEFFERSON	FACILITY NUMBER: 010206151
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above by ensuring sink 2 in room 2 and a sink identified as the kitchen food prep sink did not exceed the acceptable amount of lead allowed in a child care facility, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	By 04/28/2023 the facility will submit a written plan indicating wether the sinks that exceeded will be repaired or permanently removed,

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Loretta Dyson

LICENSING EVALUATOR NAME:

Ashley Curry

LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC809 (FAS) - (06/04)

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