010216516-1-13-2023-52-CC-LDBX-CN2QY2-20230113113424

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010216516
Report Date: 01/13/2023
Date Signed: 01/13/2023 11:34:36 AM

Document Has Been Signed on 01/13/2023 11:34 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:	LA PETITE ACADEMY - PLEASANTON		FACILITY NUMBER:	010216516
ADMINISTRATOR:	THERESA GROSS		FACILITY TYPE:	840
ADDRESS:	5725 VALLEY AVENUE		TELEPHONE:	(925) 462-7844
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94566
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 30	CENSUS: 0	DATE:	01/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Theresa Gross		TIME COMPLETED:	12:00 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 January 13, 2023 Licensing Program Analyst (LPA) Lorraine Dacanay - Breaux conducted an unannounced 1 Year Annual Required Inspection and met with Director, Theresa Gross. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Director. There were no children present during this inspection and eight (8) additional staff members. The facility consists of one (1) classroom. The facility has a infant component #010216515 and preschool component #010216514. The facility was toured for a health and safety inspection. The hours of operation are 7:00 AM- 6:00 PM, Monday -Friday. CLASSROOMS: The one (1) classroom was inspected and the room has adequate play and learning materials available. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is in the front office away from other children in care. The center has a wired smoke detector, working carbon monoxide detector, working telephone, pull down fire alarm system, and six (6) fully charged 3A40BC fire extinguishers . BATHROOMS AND TOILETING AREAS: The staff's bathroom is separate from the children's bathroom. All sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets. Supplies are available to the children. FOOD SERVICE AREAS: This facility provides lunch for the children and there are weekly menus posted at the facility. LPA observed an area where they have a refrigerator this area is clean and free of evidence of rodents and litter. There are no pesticides and other similar toxic substances stored in food storerooms. All storage containers for solid waste have tight fitting covers that are in good repair. See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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: LA PETITE ACADEMY - PLEASANTON	FACILITY NUMBER: 010216516
	VISIT DATE: 01/13/2023

NARRATIVE

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OUTDOOR PLAY AREAS: The school has a playground area. There's a play structure that is anchored with cushioning to absorb children's falls. All outdoor play structures are anchored and in good condition. There is a tall tree to provide shade.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Children's files and all staff files were reviewed. All staff files have required Health Screening and Employee Rights. All children's files contained Identification & Emergency, Personal Rights, and Medical Consent forms. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. Mandated Reporter Training was discussed, and certificates were reviewed. The center is following the sign in and out procedure. Disaster drills are being conducted at least once every 6 months at the last one conducted was on 10/05/2022. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: No IMS is being provided for this component at this time and no medication is being stored at the facility. The center is equipped with fully stocked first aid kits that are available in the classroom

California Law requires Child Care Centers licensees 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 electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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

See 809-C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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

FACILITY NAME: LA PETITE ACADEMY - PLEASANTON	FACILITY NUMBER: 010216516
	VISIT DATE: 01/13/2023

NARRATIVE

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Transportation is bring provided by the facility. Director was reminded that no child(ren) is to be left in the vehicle alone and/or unsupervised at any time.

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.

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.

There are no deficiencies site today. A notice of site visit was given and must remain posted for 30 days. Appeal Rights. Exit interview conducted and report was reviewed with the Director, Theresa Gross.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Lorraine Dacanay-Breaux
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC809 (FAS) - (06/04)

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