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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010209363
Report Date: 05/25/2022
Date Signed: 05/25/2022 10:58:01 AM

Document Has Been Signed on 05/25/2022 10:58 AM - 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:LARPD EXTENDED STUDENT SERVICES - SMITHFACILITY NUMBER:
010209363
ADMINISTRATOR:JULIE HOPKINSFACILITY TYPE:
850
ADDRESS:391 ONTARIO DRIVETELEPHONE:
(925) 960-2468
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 41DATE:
05/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Julie HopkinsTIME COMPLETED:
11:10 AM
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On May 25, 2022, at approximately 8:25 am, Licensing Program Analyst (LPA) Simerjit Kaur arrived to conduct UNANNOUNCED RANDOM REQUIRED 1 YEAR SITE INSPECTION for school age program and met with Director Julie Hopkins. Present during the inspection were 4 fingerprint cleared staff members and no children. The facility was toured for a health and safety inspection. The center is located adjunct to Emma C Smith Elementary School. The hours of operation are Monday through Friday, 7:00am to 8:30 am and 1:00pm to 6:00pm.

The center consists of 2 rooms (Room A, Room B and office, staff workroom), combined bathroom for boys and girls, outside play ground, and staff bathroom. The facility has adequate heating and lighting. There is running water, soap, and paper towels available for children to wash and dry their hands. The center does provide snack and the monthly menu is posted. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the inspection today. The center is equipped with a First Aid Kit, working telephone, carbon monoxide detector, pull down fire alarm and fire extinguishers. There is drinking water readily available to children indoors and outdoors. The floors were free of tripping hazards during today's inspection. The storage containers for solid waste have tight-fitting lids. The classrooms are equipped with age appropriate tables and chairs. There is adequate storage for children's belongings. There are school materials and art supplies stored in the storage cabinets. The facility utilize the outdoor playground with Emma C Smith Elementary School. Outdoor activity space and playground equipment was observed to be safe during today's inspection. There is cushioning underneath the anchored play structure.
The center is in compliance with the sign in and out procedure. Children and staff records were reviewed. All required documents are posted for public review. LPA reviewed and obtained facility roster. The director also has conducted and documented fire/disaster drill training on 4/15/22.
Continued on LIC809C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: LARPD EXTENDED STUDENT SERVICES - SMITH
FACILITY NUMBER: 010209363
VISIT DATE: 05/25/2022
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Staff members have current mandated reporter training Stephani Johnson completed on 8/3/21, Julie Hopkins completed on 1/11/22, and Judy Pipper completed on 4/20/21. All staff have current CPR/First Aid certificate Stephani Johnson completed on 11/29/21, Julie Hopkins completed on 3/26/21, and Judy Pipper completed on 11/29/21. There are no bodies of water at this facility during today's inspection. The facility is operating within its licensed capacity.

This facility plans to provide Incidental Medical Services – IMS. The facility has properly stored medications and required documentation. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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

Director is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $500 per person, per incident. Director was reminded of the responsibility as a mandated reporter.

Director was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. All forms can be downloaded at www.ccld.ca.gov

See 809D for deficiency.
This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/25/2022 10:58 AM - It Cannot Be Edited


Created By: Simerjit Kaur On 05/25/2022 at 10:43 AM
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: LARPD EXTENDED STUDENT SERVICES - SMITH
FACILITY NUMBER: 010209363

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101227(a)(1)
Food Service
(1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the children. Each meal shall include, at a minimum, the amount of food components as specified by Title 7, Code of Federal Regulations, Part 226.20, (Revised January 1, 1990) Requirements for Meals, for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in that expired snack foods were found in the supply cabinet and refrigerator which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/25/2022
Plan of Correction
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Facility director immediately cleared the expired foods and placed them in the trash cans.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Jason Jang
LICENSING EVALUATOR NAME:Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022


LIC809 (FAS) - (06/04)
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