013418995-8-3-2022-52-CC-JMIR-CGGQPF-20220719122040

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418995
Report Date: 07/19/2022
Date Signed: 08/03/2022 08:33:38 PM

Document Has Been Signed on 08/03/2022 08:33 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:	EXTENDED DAY CHILD CARE - GREEN SCHOOL		FACILITY NUMBER:	013418995
ADMINISTRATOR:	BECKWITH, DAISY		FACILITY TYPE:	840
ADDRESS:	3300 ANTONE WAY		TELEPHONE:	(925) 479-0785
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY: 125	TOTAL ENROLLED CHILDREN: 125	CENSUS: 40	DATE:	07/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:			TIME COMPLETED:	12:30 PM

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On 07/19/2022 at 9:15am Licensing Program Analyst (LPA) Jaylena Miller conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION. LPA met with Daisy Beckwith Site Director, also present at the time of this inspection were 6 staff and 51 children. The facility is within ratio and capacity compliance today. Upon arrival LPA provided facility representative the form LIC 125. The facility was toured to conduct a Health and Safety Inspection.

This program current operates Monday-Friday with two sessions: before school from 7:00am – 8:30am and after school from 12:00pm – 6:00pm out of classroom D-01 (Kindergarten – First Grade) and the multipurpose room (Second – Fifth Grade) however for the Summer the hours are 7:00am - 6:00pm.

The classroom and multipurpose room were inspected for age appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the cleanliness of floors and surfaces, the presence of working carbon monoxide detector, smoke detectors/fire alarms and fully charged fire extinguishers size 3A-40-BC that is accessible throughout the facility. The bathrooms have age appropriate faucets and toilets in working condition. The outdoor play area is fully fenced. There is padding under/around the climbing equipment. The play structures appear to be fully intact with no visual defects or concerns.

The facility serves lunch that is provided by the school district and the facility provides am/pm snacks, menu is also posted. LPA reviewed storage of food and reminded director that all food must be in original packaging or labeled with expiration date.

LPA did not observe any pools, hot tubs or other accessible bodies of water. Per director, there are no firearms present on the premises. Cleaning supplies/toxins are stored inaccessible to children during the inspection and all required postings are present. The center conducts and documents fire and earthquake drills once every 6 months and the logs show that drills were conducted on 7/19/2022.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

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 - GREEN SCHOOL	FACILITY NUMBER: 013418995
	VISIT DATE: 07/19/2022

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A copy of the facility personnel roster and children’s roster were available for review and copy was obtained. LPA reviewed the file of 10 children enrolled in the program and 6 staff members files, who are fingerprint cleared, proof of immunizations and completion of Mandated Reporter training for 3 of the 6 staff members present however within 90 days. Opening and Closing staff have current CPR/First Aid certification, and proof of education and/or experience was also present. Staff interview also conducted and documented.

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

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.

Facility Representative 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.

Facility Representative was reminded of the responsibility as a mandated reporter and the training's must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged facility representative to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: EXTENDED DAY CHILD CARE - GREEN SCHOOL	FACILITY NUMBER: 013418995
	VISIT DATE: 07/19/2022

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Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There are no deficiencies cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Daisy Beckwith.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

LIC809 (FAS) - (06/04)

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