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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414731
Report Date: 12/14/2022
Date Signed: 12/14/2022 12:34:21 PM

Document Has Been Signed on 12/14/2022 12:34 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 CENTERFACILITY NUMBER:
013414731
ADMINISTRATOR:SAFFI, FAWZIAFACILITY TYPE:
850
ADDRESS:560 JACKSON AVENUETELEPHONE:
(925) 455-7270
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 17DATE:
12/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:CTIME COMPLETED:
12:40 PM
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On December 14, 2022, Licensing Program Analyst (LPA) Simerjit Kaur met with Site Supervisor Cynthia Gudino Nava for UNANNOUNCED RANDOM REQUIRED 1 YEAR SITE INSPECTION. There were 2 rooms, 17 children and 7 staff members , 2 substitute teachers. There are two classrooms that are being utilize for preschool and toddler component. The toddler room is divided into two sections. The 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 room. 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. There is adequate furniture, toys and activities, which are age appropriate and in good condition. The heating and lighting is adequate. There is adequate storage for children's belongings. 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. There is drinking water readily available to children. There is a menu posted in the kitchen and classrooms. The center provides breakfast, and snacks. The center provides individual style lunch meal trays, which is prepared by Stanford Health Care- Valley Care Hospital kitchen. The isolation area for sick children is in the office. Fire and earthquake drill was conducted and documented dated 11/15/22. 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. A current children and personnel roster is obtained. Sign-in and sign-out logs were reviewed and full signatures with time of day. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the inspection. There are separate bathrooms for staff and children.
Continued on LIC 809 C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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: CAPE - JACKSON CENTER
FACILITY NUMBER: 013414731
VISIT DATE: 12/14/2022
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 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. Toddler changing tables are within reach of a sink. The center is equipped with a fully stocked first aid Kit bags. All storage containers for solid waste have tight-fitting covers that are in good repair. There are no pools or similar bodies of water at this facility. Outdoor activity space and playground equipment observed to be safe and free of hazards. Climbing equipment is properly anchored to the ground with adequate and appropriate cushioning material to absorb falls. There is a shaded area provided for the children.
All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. Children and 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.
Site Supervisor 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 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. 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/process.
An exit interview was conducted with Site Supervisor Cynthia Nava. 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: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
LIC809 (FAS) - (06/04)
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