<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213356
Report Date: 06/17/2022
Date Signed: 06/17/2022 11:32:51 AM

Document Has Been Signed on 06/17/2022 11:32 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:CAPE - WM. ORMAND III EARLY ED. CTR.FACILITY NUMBER:
010213356
ADMINISTRATOR:GURJIT KAURFACILITY TYPE:
850
ADDRESS:800 MARYLIN AVENUETELEPHONE:
(925) 443-3434
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 20DATE:
06/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Gurjit KaurTIME COMPLETED:
11:40 AM
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 June 17, 2022 at 8:30am, Licensing Program Analyst (LPA) Simerjit Kaur arrived unannounced for a Required-1 year inspection. LPA met with Facility Director Gurjit Kaur, Family Advocate Irene Pantoja. There were 20 children and 9 staff members present during the inspection. The facility is located on the campus of Marylin Elementary School. The facility was toured for a health and safety inspection. Hours of operation are Monday through Friday, 8:00am to 5:00pm.

The preschool operates out of two separate classrooms, Room A and Room C. The kitchen/food preparation and storage areas appear to be clean and free of evidence of rodents. The food is protected against contamination. The toilets and sinks were safe, sanitary and in operable condition. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the inspection. All children have individual cubbies for storage. Furniture and equipment are in good condition, and floors are free of tripping hazards. All sheets are washed in facility. All storage containers for solid waste have tight-fitting covers that are in good repair. Drinking water is available both indoors and outdoors. Facility provides breakfast, lunch and snacks to children. Menus are posted in each classroom. Medications are inaccessible to children. There are no pools or similar bodies of water at this facility. Outdoor activity space and playground equipment observed to be safe and free of hazards. Climbing equipment is properly anchored to the ground with adequate and appropriate cushioning material to absorb falls. There is a shaded area provided for the children. Fire/Disaster Drills are conducted at least every six months, and a review of the log shows the last drill was conducted 4/29/22. Required licensing documents were posted. Fire extinguishers, carbon monoxide and smoke detectors meet the State Fire Marshall standards.


Continued on LIC 809C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: CAPE - WM. ORMAND III EARLY ED. CTR.
FACILITY NUMBER: 010213356
VISIT DATE: 06/17/2022
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
26
27
28
29
30
31
32
The facility is operating within its licensed capacity. The facility is within ratio today. LPA verified both opening and closing staff have current CPR/First aid training. Sign in/out logs are maintained. Children and staff records were reviewed, and contained required licensing documents. Teachers present today meet the qualification requirements. Staff have required immunization.

Director 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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Center Sections 101173 and 101226. 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 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.


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.

There is deficiency cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Family Advocate Irene Pantoja. Appeal Rights provided.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 06/17/2022 11:32 AM - It Cannot Be Edited


Created By: Simerjit Kaur On 06/17/2022 at 11:12 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: CAPE - WM. ORMAND III EARLY ED. CTR.
FACILITY NUMBER: 010213356

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the facility director did not comply with the section cited above, which pose a potential health, safety or personal rights risk to persons in care. Facility staff does not have current mandated reporter training.
POC Due Date: 07/01/2022
Plan of Correction
1
2
3
4
Training can be found at mandatedreporterca.com. Licensee must complete Mandated Reporter Training every two years.
Facility director shall submit proof of completed mandated reporter training by 07/01/22.
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:Jason Jang
LICENSING EVALUATOR NAME:Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 06/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/17/2022


LIC809 (FAS) - (06/04)
Page: 3 of 3