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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214126
Report Date: 03/11/2022
Date Signed: 03/11/2022 10:33:17 AM

Document Has Been Signed on 03/11/2022 10:33 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 SERVICE - RANCHOFACILITY NUMBER:
010214126
ADMINISTRATOR:DICKINSON, DANAFACILITY TYPE:
840
ADDRESS:401 JACK LONDON BLVD.TELEPHONE:
(925) 960-2467
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 7DATE:
03/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:TIME COMPLETED:
10:45 AM
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On March 11, 2022, at approximately 7:30 am, 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 Dana Dickinson. Present during the inspection are 14 school age children and 2 fingerprint cleared staff members. The facility was toured for a health and safety inspection. The center is located adjunct to Rancho Los Positas Elementary School. The hours of operation are Monday through Friday, 7:00am to 8:30am and 1:00pm to 6:00pm.

The center consists of 2 rooms (Room A, Room B and office), 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 weekly menu is posted outside the door. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the inspection. 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 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 locked and stored in the storage cabinet. The facility utilize the outdoor playground with Rancho Los Positas 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. Licensee also has conducted and documented fire/disaster drill training on 2/28/22.
Continued on LIC809C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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: LARPD EXTENDED STUDENT SERVICE - RANCHO
FACILITY NUMBER: 010214126
VISIT DATE: 03/11/2022
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Staff member Erin Yeggy has current CPR/First Aid certificate (completed on 3/26/21) and do not have current mandated reporter training. The director has current mandated reporter training (completed on 3/11/22). 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. 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 $3000 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. A copy of their appeal rights provided. Exit interview conducted.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC809 (FAS) - (06/04)
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