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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013411228
Report Date: 11/23/2021
Date Signed: 11/23/2021 04:57:52 PM

Document Has Been Signed on 11/23/2021 04:57 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:KIDS CARE PLUS - PRIMETIME AT CANYON MIDDLE SCHOOLFACILITY NUMBER:
013411228
ADMINISTRATOR:DARRIN, COLLENFACILITY TYPE:
840
ADDRESS:19600 CULL CANYON ROADTELEPHONE:
(510) 538-8351
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 60TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
11/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:38 PM
MET WITH:Annaleza RoqueTIME COMPLETED:
04:57 PM
NARRATIVE
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On 11/23/2021, Licensing Program Analyst (LPA) Jonathan Williams arrived at the facility unannounced for the purposes of conducting a Case Management inspection due to facility reopening after a period of inactivity. LPA was met by Annaleza Roque, Director of Kids Care Plus - Stanton, and zero children in care. The facility operating hours are 7am-5:30pm M-F. The facility is not currently open due to holiday. Facility plans to reopen on 11/29/2021. The facility was toured to conduct a health and safety inspection.

At 3:42pm, LPA toured the facility classroom. The facility consists of one portable classroom on the site of Canyon 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, in operable condition, and free of loose, sharp, or pointed parts. Uncontaminated drinking water is available to children inside the facility. LPA observed adequate amounts of paper towels and hand soap available to children in the bathroom during today's inspection. No cleaning supplies were observed to be accessible to children during today's inspection.

At 3:55pm, LPA toured the outdoor play area. All equipment is age-appropriate and in operable condition. There are no pools, hot tubs, ponds, or any other bodies of water accessible to children during today's inspection.

At 4:04pm, LPA toured the kitchen/food preparation area. The kitchen is free of litter, garbage, and evidence of rodents or other vermin during this inspection. Food is protected from contamination and, per staff, contaminated food is discarded immediately. Food/beverages capable of rapid spoiling are properly stored. Uncontaminated drinking water is available to children inside and outside the facility.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2021
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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Document Has Been Signed on 11/23/2021 04:57 PM - It Cannot Be Edited


Created By: Jonathan Williams On 11/23/2021 at 04:33 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: KIDS CARE PLUS - PRIMETIME AT CANYON MIDDLE SCHOOL
FACILITY NUMBER: 013411228

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/23/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/07/2021
Section Cited
HSC
1596.866(a)(1)

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(a)(1) In addition to other required training, at least one director or teacher at each day care center...shall have at least 15 hours of health and safety training...
This requirement was not met as evidenced by:
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Director shall submit proof of enrollment of CPR/1st Aid renewal training for staff by the POC due date.
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Based on record review and interview, LPA determined that facility has been in operation without at least one staff member trained in pediatric CPR/1st Aid. This poses a potential health and safety risk to children in care.
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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:Wynn Norona
LICENSING EVALUATOR NAME:Jonathan Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 11/23/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/23/2021


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: KIDS CARE PLUS - PRIMETIME AT CANYON MIDDLE SCHOOL
FACILITY NUMBER: 013411228
VISIT DATE: 11/23/2021
NARRATIVE
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The facility has a fully charged 3A40BC fire extinguisher, working smoke/carbon monoxide detector (combined), and working telephone. Children's files and staff files were reviewed for proper documentation. All required forms are posted in public view, including daily activity schedule. Menus are posted. Children's roster was obtained.

Incidental Medical Services (IMS) policy was discussed. This facility does not provide IMS to children in care at this time. 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.”

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.

Director was reminded that California Law requires licensed Child Care Centers 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. LPA informed the Director that all forms can be downloaded at www.ccld.ca.gov and encouraged the Director to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Director was also reminded 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.

There is one deficiency cited today. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided to the Director and the signature on this form acknowledges receipt of these rights.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jonathan Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
LIC809 (FAS) - (06/04)
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