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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412413
Report Date: 09/20/2022
Date Signed: 09/20/2022 10:39:35 AM

Document Has Been Signed on 09/20/2022 10:39 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:EXTENDED DAY CHILD CARE - DUBLIN ELEMENTARYFACILITY NUMBER:
013412413
ADMINISTRATOR:SINCLAIR, VANESSAFACILITY TYPE:
840
ADDRESS:7997 VOMAC ROADTELEPHONE:
(925) 551-8170
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 0DATE:
09/20/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:27 AM
MET WITH:Alexandra FerraroTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Melanie Otsuji met with Director Alexandra Ferraro for an unannounced Case Management Inspection. An application was submitted for an Addition of a Room and Capacity Increase. The center has requested to add room B2 as licensed space and increase capacity from 120 school age children to 150 school aged children. The school age program is located on Dublin Elementary School campus. The program is currently utilizing the two classrooms (EDCC #1 and EDCC #2) and the Multi-Purpose Room. Hours of operation are from 7:00AM to 9:30AM and 12:15PM to 6:00PM, Monday through Friday. However staff are on site from 7AM to 6PM as needed. At the time of LPAs visit there were no children or additional staff present. A health and safety inspection was conducted inside and outside.


INDOORS: EXEMPT
OUTDOORS: EXEMPT

This facility is exempt from square footage and bathroom requirements. Facility utilizes the playground and blacktop of the elementary school. Director is aware that there is to be no commingling of the children. Drinking water is available inside and outside by way of water dispenser and bottles brought from home. Facility provides AM/PM snacks. Menus are posted. Facility has a functioning carbon monoxide detector, smoke detector and fire extinguisher. Facility has a sign in/out sheet that allows ample space for full legal signature and records time and date.

An approved Fire Clearance was received from Dublin Fire Prevention Services for 150 school aged children with an approval date of 8/18/2022.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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: EXTENDED DAY CHILD CARE - DUBLIN ELEMENTARY
FACILITY NUMBER: 013412413
VISIT DATE: 09/20/2022
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All licensing required documents are posted. Per Director, all Opening and Closing staff have current Pediatric CPR/First Aid. This facility plans to provide Incidental Medical Services – IMS. An updated Plan of Operation that includes IMS must be submitted to the Department when any changes are made. 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.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Director is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

Zero Tolerance policies were explained.
The center was found to be clean, safe, sanitary and in good repair.

There are no deficiencies cited during today's visit. A license with approval for 150 school aged children operating out of two EDCC classrooms, the Multi-Purpose Room, and Rm B2 will be issued effective, 9/20/2022.

An exit interview was conducted with Director, Alexandra Ferraro.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022
LIC809 (FAS) - (06/04)
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