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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422435
Report Date: 08/17/2023
Date Signed: 08/17/2023 11:41:35 AM

Document Has Been Signed on 08/17/2023 11:41 AM - 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:ST. RAYMOND PRESCHOOLFACILITY NUMBER:
013422435
ADMINISTRATOR:WRIGHT, MAUREENFACILITY TYPE:
850
ADDRESS:11557 SHANNON AVE.TELEPHONE:
(925) 574-7423
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 22DATE:
08/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Director, Maureen WrightTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jyoti Saini met with director, Maureen Wright 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 22 children and one staff member present today. The facility operates Monday - Friday from 7:00 AM to 6:00 PM in the early education building. 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 backpack 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. Children bathrooms have 2 toilets and 2 sinks. The bathrooms appear to be safe, sanitary, and free of any hazardous items.There is drinking water readily available for children using water bottles brought from home, and the facility refills the water bottles using a water fountain. The children bring their own snacks and lunch; however the facility does have extra nonperishable snacks for emergencies. The classroom has appropriate postings. The last Emergency Drill was conducted on 05/10/2023 and is properly logged.

LPA reviewed sign-in and out sheet. The center does not have complete record of sign in and out sheet. 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.

LPA reviewed five (5) children files. All children have a record of emergency identification information on file. Staff records reviewed were complete. All staff has a criminal record clearance on file. The site Director has a current Pediatric First Aid/CPR certificate on file. A copy of the facility personnel roster and children’s roster were available for review and copy was obtained.

see next page...

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2023
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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Document Has Been Signed on 08/17/2023 11:41 AM - It Cannot Be Edited


Created By: Jyoti Saini On 08/17/2023 at 10:47 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ST. RAYMOND PRESCHOOL
FACILITY NUMBER: 013422435

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(b)
Sign In and Sign Out
(b) The person who brings the child to, and removes the child from, the center shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above. During the inspection, LPA observed that out of 22 children only 15 children were signed in, which poses a potential health, safety or personal rights risk to children in care.
POC Due Date: 08/22/2023
Plan of Correction
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Director shall implement a sign in/out procedure and sublit a plan of correction to Community Care licensing division
( CCLD).
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023


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: ST. RAYMOND PRESCHOOL
FACILITY NUMBER: 013422435
VISIT DATE: 08/17/2023
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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.

Currently, This facility does not provides Incidental Medical Services – IMS.


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/.

Licensee 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.

See attached LIC809-D deficiency cited today, and one technical violation was given.



A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Maureen Wright.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC809 (FAS) - (06/04)
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