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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214127
Report Date: 06/03/2021
Date Signed: 06/17/2021 03:46:07 PM

Document Has Been Signed on 06/17/2021 03:46 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LARPD EXTENDED STUDENT SERVICE - MICHELLFACILITY NUMBER:
010214127
ADMINISTRATOR:SHEILA MCGUIREFACILITY TYPE:
840
ADDRESS:1001 ELAINE AVE.TELEPHONE:
(925) 960-2465
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 80TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/03/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Nancy BlairTIME COMPLETED:
01:30 PM
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DUE THE COVID-19 PANDEMIC THIS VISIT WAS CONDUCTED VIRTUALLY VIA THE PLATFORM ZOOM.

A Case Management Visit was conducted on this date 6/3/2021 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA conducted televisit with Youth Services Administrator, Nancy Blair. An application was submitted for the TEMPORARY ADDITION OF ROOM(S). The center has requested to remove Portables 2, 5, and 6 from the license and temporarily add the Computer Room and Music Room. The school age program is located on Michell Elementary School campus. The program will be licensed to utilize the Computer Room, Music Room and Multi-Purpose Room. Hours of operation are from 7:00AM to 6:00PM, Monday through Friday. A virtual health and safety inspection was conducted inside and outside.

INDOORS: EXEMPT
OUTDOORS: EXEMPT

Facility utilizes Michell Elementary School play yards and grassy areas. Facility understands they will not commingle with elementary school aged children. Drinking water is available inside and outside by way of water fountains and bottles brought from home. Menus are posted. A sample of the sign in and out logs were reviewed. Facility has a functioning carbon monoxide detector.

The center is utilizing Michell Elementary School's fire clearance for the temporary room additions. All licensing required documents are posted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2021
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 SERVICE - MICHELL
FACILITY NUMBER: 010214127
VISIT DATE: 06/03/2021
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Per Director, all staff have current Pediatric CPR/First Aid. Blacktop and grassy area is in good condition. Drinking water is available inside and outside. This facility plans to provide Individual 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.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee 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.

Zero Tolerance policies were explained.
The center was found to be clean, safe, sanitary and in good repair.

There are no deficiencies cited during this televisit. Approval of the computer room, music room, and multi-purpose room is approved as of today's date 6/3/2021.

An exit interview was conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
LIC809 (FAS) - (06/04)
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