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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420914
Report Date: 09/14/2023
Date Signed: 09/14/2023 01:58:50 PM

Document Has Been Signed on 09/14/2023 01:58 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:SCHOOL OF IMAGINATIONFACILITY NUMBER:
013420914
ADMINISTRATOR:SIGMAN, CHARLENEFACILITY TYPE:
850
ADDRESS:9801 DUBLIN BLVDTELEPHONE:
(925) 829-9552
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 87TOTAL ENROLLED CHILDREN: 87CENSUS: 69DATE:
09/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director, Charlene Sigman TIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with director, Charlene Sigman for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Staff. In addition to the director, there are 69 preschool children and 19 staff members present today. The facility does not have toddler enrollments so room number one(1) and two(2) are being used for preschool. The facility operates Monday - Friday from 8:00 AM to 5:00 PM in room #1 through room #8. The facility was inspected indoor and outdoor today for health and safety hazards and the following was observed.

There are no bodies of water, firearms, or weapons on the premises. The center is in good condition with proper temperature and ventilation and is free of any hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. A first aid kit and a first aid backpacks are available. The outdoor play area is fenced for supervision. The play structure is age-appropriate and in good condition. There are separate bathrooms for the children and staff. The bathrooms appear to be safe, sanitary, and free of any hazardous items. Mats are available for use of children. The bedding is sent home weekly to be washed by the parents. The children bring their own snacks and lunch; however the facility does have extra nonperishable snacks for emergencies. There is drinking water readily available through water bottles brought from home and water fountains available in the facility indoor and outdoor. The classroom has appropriate postings. The last Emergency Drill was conducted on 07/25/2023 and is properly logged.

LPA reviewed sign-in and out sheet. The center has a complete record of sign-in/out sheets by an authorized pick up person. There is a working fire alarm system in the facility. The Facility has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone available.

All the Children records reviewed were complete. All children have a record of emergency identification information on file. All staff has a criminal record clearance on file. The staff has a current Pediatric First Aid/CPR certificate on file and have taken Mandated Reporter training. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site always or present during off-site activities (field trips). Facility roster was reviewed and copy was obtained.

See next page...

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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: SCHOOL OF IMAGINATION
FACILITY NUMBER: 013420914
VISIT DATE: 09/14/2023
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During inspection,

Facility representative 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 discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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-care-centers/.

Facility Representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

No deficiency is 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, Charlene Sigman.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC809 (FAS) - (06/04)
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