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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423089
Report Date: 06/24/2021
Date Signed: 06/24/2021 04:59:41 PM

Document Has Been Signed on 06/24/2021 04:59 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:AFS-HEAD START RUBY BRIDGES CENTERFACILITY NUMBER:
013423089
ADMINISTRATOR:MA, CONNIEFACILITY TYPE:
850
ADDRESS:351 JACK LONDON AVENUETELEPHONE:
(510) 629-6300
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/24/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Linda Bounsalat & Julie GiesslerTIME COMPLETED:
05:00 PM
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On 6/24/21 at 3pm, Licensing Program Manager (LPM) Loretta Dyson arrived at the facility for an announced prelicensing inspection. LPM met with Linda Bounsalat and Julie Giessler. An application for a new preschool license was received for this facility. The facility will operate Monday-Friday 8am-4pm in two, three and a half hour sessions. The preschool classroom is in room number 504 on the campus of Ruby Bridges Elementary School. LPM toured all areas that will be used for children, to conduct a health and safety inspection, and the measurements are as follows:

INDOORS: 834.45 square feet= 24 children
OUTDOORS: 5665.74 square feet= 75 children
A fire clearance, with a total capacity of 24 preschoolers, was approved by Alameda City Fire Department.

LPM observe that the classroom has sufficient lighting, heating and ventilation for the safety and comfort of children and staff. LPM observed that the floor and surfaces are clean and in good repair. There is an ample supply of age appropriate toys, activities, equipment, and furniture that is in good condition. There is a total of 2 toilets, 2 urinals and 4 sinks available for children, and they are in sanitary and operational condition. There is a separate bathroom for staff. The area near the staff desk and the staff bathroom will be used for the isolation of sick children. The facility will serve breakfast, lunch and snacks, and a sample menu that is dated at least a week in advance has been received. The facility will use a water pitcher and disposable cups to provide water for children both indoors and outdoors. The facility will not have children nap, due to operating as a half day program. The facility will have parents sign in/out with a full legal signature on sheets. The facility is equipped with a fully charged 2A10BC fire extinguisher, a centralized smoke and carbon monoxide detection system, telephone, and first aid supplies. LPM did not observe any hazardous items, toxins, bodies of water or medication accessible to children today.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: AFS-HEAD START RUBY BRIDGES CENTER
FACILITY NUMBER: 013423089
VISIT DATE: 06/24/2021
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The outdoor play area is fully fenced and there is an ample supply of equipment and activities available. The outdoor play area will be shared with another program and a waiver, requesting to allow this, will be reviewed. The play structure is secure and has sufficient cushioning underneath to absorb a fall. There is shade from the trees that line the edge of the playground. LPM did not observe any dangerous conditions or hazards in the play area.

Documents have been received and reviewed, to verify that Connie Ma qualifies as a preschool director. The COVID-19 self-assessment has been provided to the licensee and LPM verified that the licensee has plans that will follow the recommendations and guidance to limit the spread of COVID-19. LPM provided postings related to COVID-19.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.

The licensee was advised to review information related to applicable regulations on Licensing’s website at www.ccld.ca.gov. LPM reminded the licensee to adhere to all requirements within the regulations at all times including supervision, personal rights, unusual incident and injury reporting, and criminal record clearance and association requirements. The licensee was encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. They were reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

The preschool license, with a capacity of 24, will be effective today 6/24/21. This report will remain on file for 3 years. An exit interview was conducted, and a copy of the report was provided.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
LIC809 (FAS) - (06/04)
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