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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700561
Report Date: 09/16/2024
Date Signed: 09/16/2024 04:04:40 PM

Document Has Been Signed on 09/16/2024 04:04 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:ABC PRESCHOOL & DAYCAREFACILITY NUMBER:
015700561
ADMINISTRATOR/
DIRECTOR:		MALHOTRA, ANUPAMAFACILITY TYPE:
850
ADDRESS:20135 SAN MIGUEL AVENUETELEPHONE:
(408) 839-5669
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 21TOTAL ENROLLED CHILDREN: 21CENSUS: 22DATE:
09/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Anupama MalhotraTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
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On 09/16/2024 at 8:30am, Licensing Program Analyst (LPA) Christina Uribe conducted an Unannounced Annual Required Inspection. LPA met with Site Director, Anupama Malhotra, also present at the time of the inspection were 4 staff & 22 children. The facility is within ratio & capacity compliance today. LPA provided facility representative the Entrance Checklist (LIC 125). The facility was toured to conduct a Health and Safety inspection. The facility currently operates 7:00am-6:00pm, Monday-Friday in two classrooms.

Classrooms: All classrooms were inspected for age-appropriate furnishings, equipment, & adequate storage for children’s belongings. LPA observed the cleanliness of floors & surfaces, the presence of a fully functional carbon monoxide detector, smoke detector/fire alarms, and a fully charged 3A40BC fire extinguisher that is accessible throughout the facility. The center is equipped with a fully stocked first-aid kit and available in the classrooms. LPA inspected the napping equipment and observed them to be stored in a healthful manner.

Food Service Areas: All center provided food items are properly labeled & stored separately from cleaning supplies. Food prep area is clean, adequately equipped, & free from hazardous materials. Snack menu is posted one week in advance, available for review, & dated. Solid waste bins are equipped with tight fitting lid.

Bathrooms: Facility has separate staff and child designated bathrooms. Toilets and faucets are in safe and sanitary operating condition. The children are able to reach the sinks, toilets, and supplies.

Outdoor Play Area: The playground outside is fenced. There are no bodies of water, or free-standing water accessible to children. There are age-appropriate outdoor toys and materials for the children. The play structure is securely installed into the ground. The ground surrounding the play structure is sufficiently padded and in good condition for safety.

Page 1 of 4 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 09/16/2024 04:04 PM - It Cannot Be Edited


Created By: Christina Uribe On 09/16/2024 at 12:59 PM
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: ABC PRESCHOOL & DAYCARE
FACILITY NUMBER: 015700561

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above as two children's Consent for Emergency Medical Treatment (LIC 627) forms are either incomplete or missing which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2024
Plan of Correction
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Licensee will ensure that all children's Consent for Emergency Medical Treatment (LIC 627) forms are complete and accurately filled out by the child's parent/guardian no later than the due date of 10/16/2024. LPA Uribe will return to the facility for record review to ensure that the plan of correction has been met.
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 & record review, the licensee did not comply with the section cited above as two children who were taken to the nearby elementary school for TK class by a staff member were not signed out by the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/16/2024
Plan of Correction
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Licenseee will ensure that all children who arrive and depart from the facility are signed in and out according to each time of occurrence. Each time that the facility takes or relieves custody of a child, the child needs to be signed in or out. Licensee wil develop a plan to ensure the requirement is met at all times no later than the due date of 10/16/2024. LPA Uribe will return to the facility for record review to ensure that the plan of correction has been met.
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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2024


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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: ABC PRESCHOOL & DAYCARE
FACILITY NUMBER: 015700561
VISIT DATE: 09/16/2024
NARRATIVE
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Records: All individuals subject to criminal record review have a clearance. LPA reviewed 10 children’s files and 6 staff files. LPA evaluated transcripts and signed the Evaluation of Teacher Qualifications (LIC 9095) form for one staff member. LPA reviewed the facility roster & personnel report. At least one opening/closing staff member has a current Pediatric CPR/First-Aid Certification. Mandated Reporter certificates were reviewed. Director was reminded of their responsibility to renew CPR/First Aid and Mandated Reporter certificates every two years. Sign in and out procedure was observed and documents reviewed. Emergency Drills are recorded and performed at least every six months. Per facility representative, there are no firearms on the premises. Documents required to be posted in a prominent area were reviewed.

Observations: At 11:40am, LPA Uribe accompanied the director to escort two children from the day care to the neighboring elementary school. The elementary school is located two properties over from the facility and is a short walk's distance. LPA Uribe observed the procedure of dropping off the afternoon TK class students and the pick up of the morning TK class students as performed each day by facility staff. LPA Uribe, the director, and the child picked up from the elementary school arrived back at the facility around 11:55am. Children who attend school at the elementary school (TK or Kindergarten) will be picked up from or dropped off at their classrooms by facility staff at the child care center. LPA Uribe observed that the facility staff who escort the children to and from the school maintained visual supervision of the children at all times while walking them to, from, and on campus of the elementary school. LPA Uribe observed the staff member walk the children onto campus and to the door of their classroom and ensured that each child entered the classroom and custody of the child was released to the school teacher.

CCLD Inspection Process: 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.

Page 2 of 4 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
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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: ABC PRESCHOOL & DAYCARE
FACILITY NUMBER: 015700561
VISIT DATE: 09/16/2024
NARRATIVE
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Criminal Record Clearance: Director 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.

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

Lead Testing: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS): Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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/resources/child-care-centers/.

Unusual Incident/Student Injury Report: Effective August 1, 2003 California Law requires Child Care 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 to the regional office by phone and the written report, LIC 624, within 7 business days.

Page 3 of 4 ***Continued on LIC 809C***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
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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: ABC PRESCHOOL & DAYCARE
FACILITY NUMBER: 015700561
VISIT DATE: 09/16/2024
NARRATIVE
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Issued during today's inspection is three (3) deficiencies and four (4) advisory notes:
  • Type B Violation: Unsafe playground structure needs to be removed or fixed due to hazardous surfaces/items.
  • Type B Violation: Two children either have missing or incomplete Consent for Emergency Medical Treatment (LIC 627) forms.
  • Type B Violation: Two children who left at 11:45am to attend school at the elementary school nearby were not signed out by facility staff.
  • Advisory Note (TV): Some staff members do not have proof of immunization against Measles (MMR) and/or Influenza.
  • Advisory Note (TV): Two staff members do not have a Health Screening Report (LIC 503) and one staff member does not have proof of TB clearance.
  • Advisory Note (TV): The required poster for information on child passenger restraint systems is not posted for public review.
  • Advisory Note (TV): Some children's files had incomplete documentation.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Appeal rights were given and reviewed. Exit interview conducted and report was reviewed with the director, Anupama Malhotra.

Page 4 of 4 ***End of Report***

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
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Page: 7 of 10
Document Has Been Signed on 09/16/2024 04:04 PM - It Cannot Be Edited


Created By: Christina Uribe On 09/16/2024 at 03:34 PM
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: ABC PRESCHOOL & DAYCARE
FACILITY NUMBER: 015700561

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(n)
(n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as one play structure in the outdoor play area is unsafe with hazardous surfaces and materials attached to the structure which poses/posed a potential health, safety or personal rights risk to persons in care. The facility was issued an advisory note (technical violation) for this same issue on 06/19/2023 and has not made the appropriate changes resulting in the issuance of this citation today.
POC Due Date: 10/16/2024
Plan of Correction
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Licensee will either remove the structure or fix all hazardous areas, surfaces, items within the play structure no later than the due date of 10/16/2024. LPA Uribe will return to the facility to inspect the appropriate changes made and the ensure that the plan of correction has been met.
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:Chandra Charles
LICENSING EVALUATOR NAME:Christina Uribe
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2024


LIC809 (FAS) - (06/04)
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