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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010215033
Report Date: 01/09/2024
Date Signed: 01/09/2024 03:46:24 PM

Document Has Been Signed on 01/09/2024 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:OAKLAND HEAD START - MANZANITAFACILITY NUMBER:
010215033
ADMINISTRATOR:TERRY CHENFACILITY TYPE:
850
ADDRESS:2701 - 22ND AVENUETELEPHONE:
(510) 535-5627
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 12DATE:
01/09/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TERRY CHENTIME COMPLETED:
04:00 PM
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On 1/9/2024 at 10:00am Licensing Program Analyst (LPA) Tasha Alexander met with Director Terry Chen for an Unannounced Required 3-Year Inspection. During the inspection were twelve (12) preschool age children and three (3) staff were present. 1 classroom was toured for a health and safety inspection. The facility operates from 8:30am – 4:30pm, Monday – Friday.

The facility has ample age appropriate materials in the classrooms that were observed to be clean and in good condition. All toxins, cleaning products, medications and hazardous materials were observed to be in inaccessible areas. There is at least one (1) fully stocked first-aid kit on site. There are carbon monoxide detectors, smoke detectors and multiple fully charged fire extinguishers as well. All sleeping mats are free from defects, properly maintained and stored. All napping equipment is clean and properly stored. All children’s bathrooms are clean, in proper working order, and well maintained. Today there are no medications to observe/review.

The outside area is clean, free from defects with ample age-appropriate materials for the children. The play structure is anchored into the ground and properly maintained. The slides are sturdy and cushioned underneath. There are two (2) storage sheds that are locked and inaccessible to the children in care. There is also plenty of shade for the children. LPA did not observe any harmful or unattended bodies of water in or around the facility.

The kitchen area is clean, well maintained, and all hazards are in inaccessible areas. All children have access to clean drinking water in and outside of the classrooms. All meals are brought in from an outside entity and served at the facility.The facility provides breakfast, lunch and snack. All food provided by the facility is properly stored and labeled.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: OAKLAND HEAD START - MANZANITA
FACILITY NUMBER: 010215033
VISIT DATE: 01/09/2024
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The facility is operating within their licensed capacity and is in ratio in all classrooms. All staff have obtained a criminal record clearance, or transfer. All required postings are made visible in the entry way of the facility. The fire/disaster drill log is complete with the last drill logged on 12/13 /23. A physical census of the children was taken and cross referenced with the sign-in and out log. All children have been properly signed in by their parent or authorized representative. LPA obtained a sample of the children’s files, a sample of the staff files, and the facility files. All files were complete.

Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. The facility does not care for infants at this time.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: OAKLAND HEAD START - MANZANITA
FACILITY NUMBER: 010215033
VISIT DATE: 01/09/2024
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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 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. END P2

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.

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.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director Terry Chen.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC809 (FAS) - (06/04)
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