013414731-12-7-2021-52-CC-SKAR-C9GUH3-20211207143516

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013414731
Report Date: 12/07/2021
Date Signed: 12/07/2021 02:35:21 PM

Document Has Been Signed on 12/07/2021 02:35 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:	CAPE - JACKSON CENTER		FACILITY NUMBER:	013414731
ADMINISTRATOR:	SAFFI, FAWZIA		FACILITY TYPE:	850
ADDRESS:	560 JACKSON AVENUE		TELEPHONE:	(925) 455-7270
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94550
CAPACITY: 36	TOTAL ENROLLED CHILDREN: 36	CENSUS: 27	DATE:	12/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Fawzia Saffi		TIME COMPLETED:	02:45 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	Licensing Program Analyst (LPA) Simerjit Kaur met with facility director Fawzia Saffi for UNANNOUNCED RANDOM REQUIRED 1 YEAR SITE INSPECTION. There were 2 rooms, 27 children and 5 qualified teachers, 1 substitute teacher and 1 assistant teacher supervising. There are two classrooms that are being utilize for preschool and toddler component. The room section located towards parking lot is Toddler Room B and room section located towards play ground is Toddler Room A. The second room is for preschool. The center is licensed to operate Monday - Friday from 8:00am to 5:00pm. On Wednesday 8:00 am to 2:30 pm. CLASSROOMS: The two classrooms inspected for preschool and a toddler option. A current children roster obtained. Sign-in and sign-out logs were reviewed and full signatures with time of day. There is adequate storage for children's belongings. There is adequate furniture, toys and activities, which are age appropriate and in good condition. The heating and lighting is adequate. There is drinking water readily available to children during today's inspection. There is a menu posted, and there are no cleaning supplies stored with food. The center provides breakfast, lunch and snack. Due to covid 19, the center provides individual style meal trays, which comes from Valley Care Hospital kitchen. There are cots, sheets available for children's use, and they are stored properly. The center washes sheets everyday for toddler component and weekly for preschool children. The facility was observed to be clean, safe, sanitary and in good repair. The isolation area for sick children is in the office. Fire and earthquake drill was conducted and documented dated 9/16/21. The center has working telephone, carbon monoxide detector, pull down fire alarm and fire extinguishers. There are no bodies of water, or free standing water, accessible to children. Per director, there are no firearms on the premises of the center. Continued on LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

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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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: CAPE - JACKSON CENTER	FACILITY NUMBER: 013414731
	VISIT DATE: 12/07/2021

NARRATIVE

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BATHROOMS AND TOILETING AREAS: There are separate bathrooms for staff and children. All toilets flushed properly during today's inspection, and there is running water, soap, and paper towels available for children to wash and dry their hands. The children are able to reach the sinks and toilets. Toddler changing tables are within reach of a sink.

OUTDOOR PLAY AREAS: There are no bodies of water accessible to children. There are age appropriate toys and materials for the children. There are play structures available to children. The center is equipped with a fully stocked first aid Kit bag near the door outside.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. 9 Children and 4 staff files were reviewed. All staff have provided proof of immunization's and the mandated reporter training. At least one opening/closing staff member has a current CPR/First Aid certificate.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment /supplies, and reviewed child's file, 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.
Licensee was reminded to visit our website at www.ccld.ca.gov to get quarterly updates on new laws and regulations.

An exit interview was conducted with Fawzia Saffi. A notice of site visit was given and must be posted for 30 days. This report must remain available for 3 years.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021

LIC809 (FAS) - (06/04)

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