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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013411163
Report Date: 08/29/2022
Date Signed: 08/29/2022 03:49:49 PM

Document Has Been Signed on 08/29/2022 03:49 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:BAY AREA CHILD CARE - OLIVEIRA CENTERFACILITY NUMBER:
013411163
ADMINISTRATOR:MOJADDEDI, MALALAYFACILITY TYPE:
840
ADDRESS:4180 ALDER AVENUETELEPHONE:
(510) 797-8613
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 50TOTAL ENROLLED CHILDREN: 34CENSUS: 19DATE:
08/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Malalay MojaddediTIME COMPLETED:
04:00 PM
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On August 29, 2022 at approximately 11:30am, LPA Haderer arrived unannounced for an annual inspection for compliance to Health and Safety. Present for the inspection was the site director Malalay Mojaddedi and no children in care. During the inspection, two teachers and children arrived. The hours of operation remain 7:00am to 6:00pm.

The facility is a single portable room operated on the campus of Olivera elementary school. Children use the school playground yard and grass area. Everything is in safe condition and free from sharp, loose or pointed parts and the areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. Shade was available in the play areas and teachers are always present.



The facility has 2 fully charged 3A40BC fire extinguishers by the main door and westerly exit. The last annual inspection was done 8/18/2022. There is a working carbon monoxide detector (tested and working). Disaster drills are conducted every month, the last drill was conducted May 24, 2022, then next drill is scheduled in one week.

The facility is clean and well organized with ample age appropriate furnishings and equipment. Surfaces including floors and counter tops are clean and toxic free. There were no hazardous items/toxins observed to be accessible to children in care today. There are no bodies of water accessible to children in care. Heating and ventilation is acceptable. Posted documents include: License; snack menu; daily schedule; emergency disaster plan; Parent’s Rights’ Personal Rights; seatbelt laws.

There are children’s restroom facilities on campus with two toilets and three sinks (girls) and one toilet, two urinals and two sinks (boys). The sinks have functioning water taps with appropriate hand washing signs. There are enough towels and soap supplies. All toilets, hand washing and cleaning areas are in safe and sanitary operating condition.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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: BAY AREA CHILD CARE - OLIVEIRA CENTER
FACILITY NUMBER: 013411163
VISIT DATE: 08/29/2022
NARRATIVE
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Children bring their own water bottles and water is also available inside and outside the classroom. The sign in/out sheets were reviewed. Classrooms have trash cans with tight fitting cover for the disposal of solid waste. The facility has two children that require incidental medication (EpiPen’s, inhalers and anti-histamines for allergies). EpiPens for one child were expired, see LIC809D for deficiency. All other medications were not expired.

Children's records were reviewed: LPA requested and reviewed facility roster. All files selected were complete and in good order.

Staff files were reviewed. All staff subjected to criminal review have been cleared and associated to the facility. All staff have current Mandated Reporter certificates, CPR/1st aid certificates were current. At least one staff opening and closing staff has valid CPR/1st Aid certificates. Two staff were missing immunization records, and one staff was missing the Health Screening document. See LIC809D for deficiencies.

Site 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.

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

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/inspection-process.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
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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: BAY AREA CHILD CARE - OLIVEIRA CENTER
FACILITY NUMBER: 013411163
VISIT DATE: 08/29/2022
NARRATIVE
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There were 3 deficiencies issued during today’s inspection, see LIC809D for details.

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

Exit interview conducted and report was reviewed with the Site Director Malalay Mojaddedi.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/29/2022 03:49 PM - It Cannot Be Edited


Created By: Russell Haderer On 08/29/2022 at 03:21 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: BAY AREA CHILD CARE - OLIVEIRA CENTER
FACILITY NUMBER: 013411163

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that two staff member's files were missing proof of measles vaccination (or proof of immunity) and one staff member's file was missing proof of pertussis vaccination which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2022
Plan of Correction
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Staff members will provide proof of immunization, site director will place these records in the personnel file.
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
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Based on record review, the licensee did not comply with the section cited above in that one staff member's file was missing the LIC 503 Health Screening Report completed by their physician which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2022
Plan of Correction
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Staff member will obtain a Health Screening Report form their physician and provide it to the site director to keep in their personnel file.
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:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/29/2022 03:49 PM - It Cannot Be Edited


Created By: Russell Haderer On 08/29/2022 at 03:21 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: BAY AREA CHILD CARE - OLIVEIRA CENTER
FACILITY NUMBER: 013411163

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(2)
Health-Related Services
(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
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Based on observation, the licensee did not comply with the section cited above in that one child's EpiPens were found to be expired. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/02/2022
Plan of Correction
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Site Director will return the expired EpiPen medication to the parents and obtain un-expired EpiPens. All Incidental Medical Plans should be followed and medications checked on a regular basis to ensure that no medications become expired.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Chandra Charles
LICENSING EVALUATOR NAME:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2022


LIC809 (FAS) - (06/04)
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