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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211918
Report Date: 04/21/2023
Date Signed: 04/21/2023 10:08:19 AM

Document Has Been Signed on 04/21/2023 10:08 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
OAKLAND SOUTH EAST, 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: 14DATE:
04/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Rachel KarkazisTIME COMPLETED:
10:15 AM
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On April 21, 2023, Licensing Program Analyst (LPA) Simerjit Kaur arrived to conduct UNANNOUNCED RANDOM REQUIRED 1 YEAR SITE INSPECTION for Title 5 school age program and met with Director Rachel Karkazis. Present during the inspection, Licensing Program Manager Jason Jang arrived. Present during the inspection, are 14 school age children and 3 fingerprint cleared staff members. The facility was toured for a health and safety inspection. The center is located on the campus of Jackson Elementary School. The hours of operation are Monday through Friday, 7:00am to 8:30am and 1:00pm-6:00pm.

The center consists of Room A, and Room B, Room 32, Multipurpose room, office, combined bathroom for boys and girls, outside play ground, 2 kitchens and 2 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 provide snacks and the weekly menu is posted outside the door. 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. Alarm system is operated by Jackson Elementary School. 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 covers.
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 cabinet. The facility utilize the outdoor playground with Jackson 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.
Continued on LIC809C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: LARPD EXTENDED STUDENT SERVICES - JACKSON
FACILITY NUMBER: 010211918
VISIT DATE: 04/21/2023
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The center is in compliance with the sign in and out procedure. Children and staff files were reviewed. All required documents are posted for public review. LPA and LPM obtained facility roster. The director also has conducted and documented fire/disaster drill training on 3/3/23. All staff have current First Aid & CPR and current Mandated Reporter Trainings completed. 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
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: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023
LIC809 (FAS) - (06/04)
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