013414731-12-8-2023-52-CC-SKAR-CYBUBP-20231208142641

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013414731
Report Date: 12/08/2023
Date Signed: 12/08/2023 02:26:47 PM

Document Has Been Signed on 12/08/2023 02:26 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
OAKLAND SOUTH EAST, 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: 22	DATE:	12/08/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Maria Medina		TIME COMPLETED:	02:40 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	On December 8, 2023, Licensing Program Analyst (LPA) Simerjit Kaur arrived for UNANNOUNCED RANDOM REQUIRED SITE INSPECTION. LPA met with Site Director Maria Medina, Family Advocate Claudia Cordero, and Child Development Educator Norma Castaneda. There were 2 rooms, 22 children and 6 staff members including 1 substitute. The facility is located on the campus of Jackson Elementary School. The facility was toured for a health and safety inspection. The center is licensed to operate Monday - Friday from 8:00am to 5:00pm. On Wednesday 8:00 am to 2:30 pm. CLASSROOMS: There are two classrooms that are being utilize for preschool and toddler component. Room A is utilizes for toddlers and Room B is utilizes for preschool age children. There is adequate furniture, toys and activities, which are age appropriate and in good condition. The heating and lighting is adequate. The facility was observed to be clean, safe, sanitary and in good repair. There is adequate storage for children's belongings. There are cots, sheets available for children's use, and are stored properly. The center washes sheets everyday for toddler component and weekly for preschool children. There is drinking water readily available from pitchers to children indoor and outdoor. There is a menu posted in the kitchen. The center provides breakfast, and snacks. The lunch is prepared by Stanford Health Care- Hospital kitchen. The isolation area for sick children is in the office. Fire and earthquake drill was conducted and documented dated 10/16/23. 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. A current children is obtained. The facility utilizes Child Plus CPA app for Sign-in and sign-out. 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. Toddler changing tables are within reach of a sink. The center is equipped with a fully stocked first aid Kits. Continued on LIC 809 C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CAPE - JACKSON CENTER	FACILITY NUMBER: 013414731
	VISIT DATE: 12/08/2023

NARRATIVE

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All storage containers for solid waste have tight-fitting covers that are in good repair. 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 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. 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.

Facility director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing information. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.
See 809C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CAPE - JACKSON CENTER	FACILITY NUMBER: 013414731
	VISIT DATE: 12/08/2023

NARRATIVE

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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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted Child Development Educator Norma Castaneda and director Maria Medina.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

LIC809 (FAS) - (06/04)

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