015700534-4-27-2022-52-CC-EWOS-CDVSD9-20220427134646

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700534
Report Date: 04/27/2022
Date Signed: 04/27/2022 01:46:54 PM

Document Has Been Signed on 04/27/2022 01:46 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:	CAPE CAL SAFE BURKE CENTER		FACILITY NUMBER:	015700534
ADMINISTRATOR:	CURIEL, VANESSA		FACILITY TYPE:	830
ADDRESS:	612 WEST A STREET		TELEPHONE:	(925) 443-3434
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY: 16	TOTAL ENROLLED CHILDREN: 16	CENSUS: 1	DATE:	04/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Jamila Mohamed		TIME COMPLETED:	02:00 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 27, 2022 at 10:35 AM., Licensing Program Analyst (LPA) Elimika Woods conducted an unannounced Annual Required Inspection and met with the facility representative, Jamila Mohamed. LPA disclosed the purpose of the inspection and was granted entry into the facility by the representative. There were one (1) toddler present during this inspection and one (1) additional staff member. The facility consists of two (2) classrooms and this facility has a toddler option room (B). The facility was toured for a health and safety inspection. The hours of operation are 8:00 AM-4:30 PM, Monday -Friday CLASSROOMS: The two (2) classrooms were inspected. There are adequate play and learning materials available. The floors, furniture, and equipment are age appropriate and in good repair. There is adequate heating/air conditioning, ventilation and lighting. The diaper changing tables are within arms reach of a sink. The Isolation area is the director's office, away from other children in care. The center has a working smoke detector, working carbon monoxide detector, working telephone, pull down fire alarm system, and four (4) fully charged 3A40BC fire extinguishers. BATHROOMS AND TOILETING AREAS: There are two four (4) sinks and three (3) toilets available to children and the staff's bathroom is separate from the children's bathroom. All sinks and faucets are in safe and sanitary operating condition. The children can reach the sinks and toilets and supplies are available to the children. FOOD SERVICE AREAS: This facility provides breakfast, lunch, and snacks to infants. There are weekly menus posted at the facility. There are food preparation areas in each classroom. LPA observed an area where they have a refrigerators those areas are clean and free of evidence of rodents. Pesticides and other similar toxic substances are not stored in cabinets that contains food. All storage containers for solid waste have tight fitting covers that are in good repair. See 809-C

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: CAPE CAL SAFE BURKE CENTER	FACILITY NUMBER: 015700534
	VISIT DATE: 04/27/2022

NARRATIVE

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OUTDOOR PLAY AREAS: The infant yard is separate from the toddlers and there's a play structure that has cushioning to absorb falls. There's also a canopy that provides shade to children while at play. The staff brings the children water bottles and cups to the yard to keep them hydrated.

RECORDS: All individuals subject to criminal record review have a clearance or exemption and have been associated to the facility. One (1) child's file and one (1) staff file were reviewed around 11:15 AM. All staff files have required Health Screening, and Employee Rights and all children files contains Personal Rights, Identification and Emergency, and Medical Consent forms. LPA reviewed the facility roster and obtained a copy. At least one opening/ closing staff member has a current CPR & First Aid Certificate. Mandated Reporter Training was discussed, and certificates were reviewed. Director's CPR and First Aid certificate is current and expires on 10/2023. The center is in compliance with the sign in and out procedure. Disaster drills are being conducted at least once every 6 months and the last one conducted was on 04/19/2022. All required documents are posted in a public accessible area.

HEALTH RELATED SERVICES: There's no IMS being provided at this time and no medication being stored at the facility. The center is equipped with a fully stocked first aid kits that are available in the classrooms.

California Law requires Child Care Centers 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 by phone, fax, or electronic mail. Roster of the children must be properly maintained, and fire/disaster drill every six months must be documented.

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 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.

See 809-C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

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: CAPE CAL SAFE BURKE CENTER	FACILITY NUMBER: 015700534
	VISIT DATE: 04/27/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

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.

There are no deficiency 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, Jamila Mohamed.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Elimika Woods
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022

LIC809 (FAS) - (06/04)

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