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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214002
Report Date: 04/21/2023
Date Signed: 04/21/2023 05:36:16 PM

Document Has Been Signed on 04/21/2023 05:36 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ADVENTURE TIME - PARKMONTFACILITY NUMBER:
010214002
ADMINISTRATOR:SANDERS, VALINAFACILITY TYPE:
840
ADDRESS:2601 PARKSIDE DRIVETELEPHONE:
(510) 713-2011
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 115TOTAL ENROLLED CHILDREN: 75CENSUS: 49DATE:
04/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Valina SandersTIME COMPLETED:
05:45 PM
NARRATIVE
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On April 21, 2023 at approximately 2:00pm, LPA Haderer arrived unannounced for an annual inspection for compliance to Health and Safety. Present for the inspection was the site director Valina Sanders, five teachers and 49 children in care (all school age). The center currently operates from 7:00 to 6:00PM, the center is in ratio today.

The child care center operates in a large portable room on the campus of Parkmont Elementary School. The children use the school yard and playground, all equipment is in safe condition and free from sharp, loose, or pointed parts and the areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. Access to drinking water is available and teachers are always present.



All documents required to be posted were appropriately posted on the walls: License; Emergency Disaster Plan; Earthquake Preparedness checklist; Notification of Parents Rights; Personal rights; Child seatbelt laws; menus; daily activity schedules. One waiver for the facility was posted regarding outdoor shared space with the elementary school.

The facility has 2 fully charged 3A40BC fire extinguishers, one mounted next to each door in the classroom. The last annual inspection was done 7-26-2022. Fremont Alarm conducts fire inspections, the last one was completed 11/27/2022, all alarms were tested and properly functioning. The carbon monoxide detector was tested and functioning. Heating and ventilation in the classroom is acceptable. Disaster drills are conducted at least once each month, the last drill was conducted 3-07-2023.

The facility is clean and well organized with ample age appropriate furnishings and equipment. Surfaces including floors and counter tops are clean and toxic free. Hazardous items/toxins are kept in a locked cabinet in the staff kitchen area out of the access of children. No bodies of water are accessible to children in care.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
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: ADVENTURE TIME - PARKMONT
FACILITY NUMBER: 010214002
VISIT DATE: 04/21/2023
NARRATIVE
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The facility does not provide lunch, snacks are provided. During the inspection, some expired snack foods were found in the cupboard and expired mayonnaise in the refrigerator. See LIC809D for deficiency.

Children use the school bathrooms on campus, children are escorted in groups when they need to use the facilities. The staff has a separate adult bathroom located on campus.

The sign in/out sheets were reviewed and are accurate. Classrooms have trash cans with tight fitting cover for disposal of solid waste. There are 3 children that require incidental medication (EpiPen’s and antihistamines), and signed parent authorization forms were in the file.



Children's records were reviewed: LPA requested and reviewed facility roster. All files selected were complete and up to date. Staff files were reviewed. Opening and closing staff have current CPR and first aid training. Staff files were missing a Health History Report, proof of measles vaccine (MMR), proof of pertussis (tdap) and TB clearance, and proof of early childhood development (ECD) units. See LIC809D for deficiencies.

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 Centers 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

Site 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.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
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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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: ADVENTURE TIME - PARKMONT
FACILITY NUMBER: 010214002
VISIT DATE: 04/21/2023
NARRATIVE
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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/inspection-process.

There four deficiencies cited today, please see LIC809D for details. Missing health screening reports, immunizations, early childhood development units and expired foods.

A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with the site supervisor Valina Sanders.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
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)
Page: 3 of 6
Document Has Been Signed on 04/21/2023 05:36 PM - It Cannot Be Edited


Created By: Russell Haderer On 04/21/2023 at 04:48 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: ADVENTURE TIME - PARKMONT
FACILITY NUMBER: 010214002

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record reviews, the licensee did not comply with the section cited above in that staff members were missing immunization records for measles, tdap, TB and flu shot (or declination) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/01/2023
Plan of Correction
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Licensee to collect all missing immunization records for all staff and ensure any new staff members will have records in their on-site personnel files.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on, the licensee did not comply with the section cited above in that two staff members are missing a health screening reports including TB results which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/01/2023
Plan of Correction
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Licensee to ensure all staff have completed a health screening report. The completed physician's report is to be kept in the personnel files for all employed staff.
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:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2023


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 04/21/2023 05:36 PM - It Cannot Be Edited


Created By: Russell Haderer On 04/21/2023 at 04:48 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: ADVENTURE TIME - PARKMONT
FACILITY NUMBER: 010214002

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.1(b)(1)
Teacher Qualifications and Duties
(1) A teacher shall have completed, with passing grades, at least six postsecondary semester or equivalent quarter units of the education requirement specified in (c)(1) below; or shall have obtained a Child Development Assistant Permit issued by the California Commission on Teacher Credentialing.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that teaching staff members do not have ECDs in their files and an aide file does not have a record of current enrollment which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/01/2023
Plan of Correction
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Licensee to collect all transcripts to show completion of ECDs or staff must enroll in classes to obtain them.
Type B
Section Cited
CCR
101227(a)(1)
Food Service
(a) In child care centers providing meals to children, the following shall apply: (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, the licensee did not comply with the section cited above in that expired snacks were in the cupboard and expired mayonnaise was in the refrigerator which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/21/2023
Plan of Correction
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Site director disposed of expired foods and will conduct ongoing checks of all snack and refrigerated foods to ensure to remove any expired foods.
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:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2023


LIC809 (FAS) - (06/04)
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