013419494-4-22-2022-52-CC-MOTI-CDQRD9-20220422125534

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419494
Report Date: 04/22/2022
Date Signed: 04/22/2022 12:55:40 PM

Document Has Been Signed on 04/22/2022 12:55 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:	PALM ACADEMY		FACILITY NUMBER:	013419494
ADMINISTRATOR:	YEN NGUYEN		FACILITY TYPE:	840
ADDRESS:	2856 WASHINGTON BLVD		TELEPHONE:	(510) 979-9794
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY: 72	TOTAL ENROLLED CHILDREN: 30	CENSUS: 6	DATE:	04/22/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:34 AM
MET WITH:	Ruth Yong		TIME COMPLETED:	01:00 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 April 22, 2022 Licensing Program Analyst (LPA) Melanie Otsuji arrived to conduct a 1 YEAR REQUIRED inspection. LPA met with Owner/Administrator Ruth Yong and toured the facility for a health and safety inspection. Present at the time of this inspection was 1 teacher and 6 school aged children. The facility has multiple components on site (Infant, Preschool and School Age). School Age children were currently utilizing Room 6 during today's visit. There is an outdoor black top area that the children utilize. There are separate boys and girls bathrooms available in the building next door adjacent to the playground area. Heating and ventilation is acceptable. All required posted documents were found to be in compliance and prominently posted in public places. There are fully charged fire extinguishers readily available. The facility has a working carbon monoxide detector, and smoke detectors. The facility has monthly fire and/or earthquake drills, the last one completed was in April 2022. The school currently provides lunch and AM/PM snacks to children in care. 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. There are no bodies of water accessible to children in care. All hazardous materials and toxins are kept out of the reach of children. The facility uses a traditional sign-in/sign-out log. All children present were properly signed in. The classrooms has trash bins with tight fitting covers to dispose of solid waste. 1 staff file and 6 children files were reviewed. All files were found to be complete.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

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: PALM ACADEMY	FACILITY NUMBER: 013419494
	VISIT DATE: 04/22/2022

NARRATIVE

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Administrator 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 plans to provide Incidental Medical Services – IMS. 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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Administrator, Ruth Yong.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2022

LIC809 (FAS) - (06/04)

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