010214127-2-17-2023-52-CC-SKAR-CP5PUJ-20230217103736

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010214127
Report Date: 02/17/2023
Date Signed: 02/17/2023 10:37:43 AM

Document Has Been Signed on 02/17/2023 10:37 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 - MICHELL		FACILITY NUMBER:	010214127
ADMINISTRATOR:	SHEILA MCGUIRE		FACILITY TYPE:	840
ADDRESS:	1001 ELAINE AVE.		TELEPHONE:	(925) 960-2465
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94550
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS: 38	DATE:	02/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Sheila Mcguire		TIME COMPLETED:	10:45 AM

NARRATIVE

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On February 17, 2023, Licensing Program Analyst (LPA) Simerjit Kaur conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION for School Age component and met with site director Sheila Mcguire. The facility was toured to conduct a Health and Safety Inspection. The school age component is located on the campus of Joe Michell K-8th School. There were 4 staff members and 38 children present during the inspection. The facility is within ratio and capacity compliance today. The facility operates Monday - Friday from 7:00am - 10:00am and 12:30pm - 6:00pm.
This component operates out of 2 classrooms. There are adequate play and learning materials available. Furniture and equipment is age appropriate and in good repair. There is adequate heating, ventilation and lighting. There is individual storage space for each child. All storage areas and cabinets for poisons are locked. There are working carbon monoxide detectors in each classroom, fire extinguisher and alarm system through Joe Michell K-8th School.

There are separate bathrooms for staff and the children. The bathrooms for children are located in the classrooms. Toilets and faucets are working properly. Adequate lighting is provided in all bathrooms. All required postings are posted. The facility serves PM snacks. During full day, facility serves AM/PM snacks. The menu is also posted for review. Drinking water is available inside and outside.

There are age appropriate play equipment, and materials for the school age children. The first aid kit is available in the classroom. Sign-in and sign-out logs were reviewed to verify signatures. LPA reviewed staff file and children files. All opener and closer of facility have CPR and First Aid certificates.

See LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: LARPD EXTENDED STUDENT SERVICE - MICHELL	FACILITY NUMBER: 010214127
	VISIT DATE: 02/17/2023

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All required forms were posted in a public accessible area. There are no bodies of water accessible to children. Per director there are no firearms on the premises. A copy of the children’s roster and facility roster was obtained.

Facility representative 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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted with Teacher Jenny Aragon.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/17/2023 10:37 AM - It Cannot Be Edited

Created By: Simerjit Kaur On 02/17/2023 at 10:15 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: LARPD EXTENDED STUDENT SERVICE - MICHELL	FACILITY NUMBER: 010214127
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(2)

All prescription and nonprescription medications shall be maintained with the child's name and shall be dated. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in that one child's EpiPen and Zartac were found to be expired, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/24/2023
	Plan of Correction
1 2 3 4	The facility director will return the expired EpiPen and Zartac medicataion to the parents and obtain un-expired EpiPen. All Incidental Medical Plans should be followed and medications checked on a regular basis to ensure that no expired medications are kept in facility.

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: 02/17/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

LIC809 (FAS) - (06/04)

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