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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013412488
Report Date: 11/17/2022
Date Signed: 11/17/2022 03:48:13 PM

Document Has Been Signed on 11/17/2022 03:48 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:LITTLE STARS PRESCHOOLFACILITY NUMBER:
013412488
ADMINISTRATOR:LEE, WILLIAMFACILITY TYPE:
850
ADDRESS:169 - 14TH STREETTELEPHONE:
(510) 286-9800
CITY:OAKLANDSTATE: CAZIP CODE:
94612
CAPACITY: 48TOTAL ENROLLED CHILDREN: 37CENSUS: 30DATE:
11/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:William LeeTIME COMPLETED:
02:30 PM
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On November 17, 2022 at approximately 9:15am Licensing Program Analyst (LPA) Haderer arrived unannounced and met with site director William Lee to conduct an annual inspection for health and safety. There were 6 teachers and a cook fingerprint cleared and associated to the facility, and 30 children in care. The facility is in ratio today. The center location also has an infant center and school age license. The inspection today was for the Preschool and School Age licenses (not the infant license), the physical inspections were done simultaneously.

The preschool operates out of 3 dedicated preschool classrooms including: Little Starts; Happy Star and Shining Star (combined); and Bright Stars and an off-limits kitchen area. Children’s bathrooms are available with four toilets and two sinks; and separate bathrooms for school age children. There are enough towels and soap supplies. The staff have separate adult bathroom.

Disaster drills are conducted at least once every six months, the last drill was conducted June 12, 2022. The facility has multiple fully charged 3A40BC and fire extinguishers throughout the building. The last annual inspection was completed March 7, 2022. Smoke detectors and carbon monoxide detectors were available and tested. Heating and ventilation in the classroom are acceptable.



The children share a large playground area. All equipment was inspected and is in safe condition and free from sharp, loose or pointed parts. Areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. There is ample shade available and access to drinking water is available.

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. Hazardous items/toxins are kept in staff storerooms out of the access of children. There are no bodies of water accessible to children in care. The facility provides snacks and lunch for the children, monthly menus were available and posted.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LITTLE STARS PRESCHOOL
FACILITY NUMBER: 013412488
VISIT DATE: 11/17/2022
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Any milk/formula bottles brought from home were properly labeled. Food on premises was checked, no expired foods were found, there was non-fat milk available for the children.

The sign in/out sheets were reviewed are accurate. Classrooms have trash cans for the disposal of solid waste. There is one child that requires IMS (EpiPen), however, the required Parent Consent form (LIC9221) was missing from the child’s file (See LIC809D for deficiency). Medications are stored out of the reach of children.



Children's records were reviewed, LPA requested and reviewed children’s facility roster. All children’s files were complete and in good order. Staff files were reviewed. Opening and closing staff have current CPR and first aid training. All staff subjected to criminal review have been cleared and associated to the facility. Some staff files were missing proof of measles, pertussis and flu shot vaccinations (see LIC809D for deficiency).

All documents required to be posted were appropriately posted on the walls: License; Emergency Disaster Plan; Earthquake Preparedness checklist; Notification of Parents Rights; Personal rights; Child seatbelt laws; menus; daily activity schedules.

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

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.

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

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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: LITTLE STARS PRESCHOOL
FACILITY NUMBER: 013412488
VISIT DATE: 11/17/2022
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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.

There were 2 deficiencies issued today, see LIC809D for details:


- Staff files were missing proof of measles, pertussis and flu shot vaccinations
- Child requiring EpiPen was missing signed Parent Consent for to administer medication

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 William Lee.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/17/2022 03:48 PM - It Cannot Be Edited


Created By: Russell Haderer On 11/17/2022 at 02:34 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: LITTLE STARS PRESCHOOL
FACILITY NUMBER: 013412488

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2022

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 staff files were missing proof of measles, pertussis and flu shot vaccinations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2022
Plan of Correction
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Staff files will be inventoried for 100% compliance to immunization requirements (if flu shot is declined, a signed and dated declination must be present in the file).
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

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 a child needing EpiPen did not have parent consent form in her file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/21/2022
Plan of Correction
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Site director will obtain a completed and signed LIC9221 form from the parents.
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: 11/17/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022


LIC809 (FAS) - (06/04)
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