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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211918
Report Date: 06/15/2022
Date Signed: 06/15/2022 11:43:10 AM

Document Has Been Signed on 06/15/2022 11:43 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 - JACKSONFACILITY NUMBER:
010211918
ADMINISTRATOR:CAMBEROS, RITAFACILITY TYPE:
840
ADDRESS:554 JACKSON AVENUETELEPHONE:
(925) 960-2463
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 57DATE:
06/15/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Rachel KarkazisTIME COMPLETED:
11:45 AM
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A Case Management Visit was conducted on this date 6/15/2022 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA met with Director, Rachel Karkazis. An application was submitted for an Addition of a Room with no change to capacity. The center has requested to add ROOM 32 as licensed space. The school age program is located on Jackson Elementary School campus. The program is currently utilizing Room PORTABLES A, B and MULTI-PURPOSE ROOM on school grounds. Hours of operation are from 7:00AM to 6:00PM during the summer. During the school year 7:00AM - 8:30AM and 12:30PM-6:00PM Monday through Friday. Present today were 6 staff members and 57 children. A health and safety inspection was conducted inside and outside.

INDOORS: EXEMPT
OUTDOORS: EXEMPT

Facility utilizes Jackson Elementary playground structures, blacktop and grassy area and does not commingle with the elementary school children. Drinking water is available inside and outside by way of water fountains and bottles brought from home. Facility provides AM/PM snacks. Menus are posted. Lunch is brought from home. Facility has a functioning carbon monoxide detector, smoke detector and fire extinguisher. Facility has a sign in/out sheet that allows ample space for full legal signature and records time and date. Sign in/out logs were checked and matches current census. Per Director, all Opening and Closing staff have current Pediatric CPR/First Aid. Playground equipment is in good condition.

Initially facility requested to add Room 33 as licensed space. The center has received an approved fire clearance from Livermore-Pleasanton Fire Department on 6/3/2022 for Room 33. On 6/6/2022 facility requested to add Room 32 instead. LPA obtained a copy of the Jackson Elementary School District's campus-wide cleared fire inspection report which includes Room 32. Clearance was received by the school on 5/31/2022. All licensing required documents are posted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2022
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 - JACKSON
FACILITY NUMBER: 010211918
VISIT DATE: 06/15/2022
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This facility plans to provide Incidental Medical Services – IMS. An updated Plan of Operation that includes IMS must be submitted to the Department when any changes are made. 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.

Appeal rights, zero tolerance policies, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Director is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

The center was found to be clean, safe, sanitary and in good repair.

There are no deficiencies cited during today's visit. A license approving use of Room 32, and previously licensed space Portable A, Portable B, Multi-purpose Room, and elementary school playground is effective on today's date, 06/15/2022.

An exit interview was conducted with Director, Rachel Karkazis.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
LIC809 (FAS) - (06/04)
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