010214924-11-8-2023-52-CC-JJAN-CXDVPP-20231108153706

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010214924
Report Date: 11/08/2023
Date Signed: 11/08/2023 03:37:21 PM

Document Has Been Signed on 11/08/2023 03:37 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	ADVENTURE TIME - WARWICK		FACILITY NUMBER:	010214924
ADMINISTRATOR:	SANTOS, LINDA		FACILITY TYPE:	840
ADDRESS:	3375 WARWICK ROAD		TELEPHONE:	(510) 797-6122
CITY:	FREMONT	STATE: CA	ZIP CODE:	94555
CAPACITY: 108	TOTAL ENROLLED CHILDREN: 108	CENSUS: 24	DATE:	11/08/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Linda Santos		TIME COMPLETED:	03:45 PM

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 11/08/2023 at 12:45PM, Licensing Program Analyst (LPA) Jaleesa met with Director Linda Santos for an Unannounced Required Inspection. Present for this inspection are 4 fingerprint cleared staff and 24 school aged children in care. Facility operating hours are 7:00AM - 6:00PM Monday to Friday. The facility was toured to conduct a health and safety inspection. At 12:55PM, LPA toured the facility classroom. The facility operates in a portable on the site of Warwick Elementary School. The classroom is tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the classroom. All hazardous materials and toxins including disinfectants and cleaning solutions were observed to be made inaccessible to children during today's inspection. Furniture accessible to children was observed to be age-appropriate. The facility is providing filtered drinking water from a water cooler with disposable cups to children inside and outside the facility. LPA reviewed storage and documentation of children's medications; all medications are made inaccessible to children as it is kept in a locked cabinet and medications are in original containers with unaltered instructions and are not expired. There is one fully charged fire extinguisher. There is also a working carbon monoxide detector, smoke detector and working telephone. All required forms are posted in public view. Children are able to bring their own food or the facility will provide meals from the school cafeteria. LPA toured the outdoor play area. The facility is sharing bathrooms and two play structures with the Warwick elementary school children. The schedule is staggered from the elementary school for outdoor play. The play structures are surrounded by tan bark to cushion falls. There is also a separate staff bathroom located on the premises. There are no bodies of water accessible to children at the time of inspection. Continued on 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ADVENTURE TIME - WARWICK	FACILITY NUMBER: 010214924
	VISIT DATE: 11/08/2023

NARRATIVE

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At 1:30PM, LPA reviewed 5 children's files and 5 staff files. LPA observed 3 staff files had expired or missing mandated reporter training. LPA reminded Director that Mandated Reporter training is due every 2 years from the dated issued on the certificate. LPA also observed 1 staff file with an incomplete health screening with no doctors signature. There is at least one staff member on the premises with CPR and First Aid training. Disaster drills are conducted at least once every six months. The facility last conducted their drill on October 9, 2023.

There were 2 deficiencies cited on today's visit. See 809-D

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP).

Continued on 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ADVENTURE TIME - WARWICK	FACILITY NUMBER: 010214924
	VISIT DATE: 11/08/2023

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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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care- centers/.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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

Exit interview conducted and report was reviewed with the facility representative Linda Santos.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/08/2023 03:37 PM - It Cannot Be Edited

Created By: Jaleesa Jackson On 11/08/2023 at 03:08 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 - WARWICK	FACILITY NUMBER: 010214924
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/08/2023

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 licensee did not comply with the section cited above in 3 out of 5 staff did not have current mandated reporter training which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/29/2023
	Plan of Correction
1 2 3 4	Director will email by POC date the 3 missing staffs completed Mandated Reporter certificates.

Type B

Section Cited

CCR

101216(g)(2)

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 5 staff did not have a signature on the health screening in employees file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/29/2023
	Plan of Correction
1 2 3 4	Director will email the the completed health screening with physician that completed the health screening signature and printed name to LPA by POC date.

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:

Jaleesa Jackson

LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC809 (FAS) - (06/04)

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