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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700607
Report Date: 07/14/2022
Date Signed: 07/14/2022 02:04:41 PM

Document Has Been Signed on 07/14/2022 02:04 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:LITTLE HEARTS LEARNING CENTER DBA SAFARI KIDFACILITY NUMBER:
015700607
ADMINISTRATOR:TULSI, GAGANFACILITY TYPE:
850
ADDRESS:2500 POSITANO PARKWAYTELEPHONE:
(925) 215-8620
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 165TOTAL ENROLLED CHILDREN: 165CENSUS: DATE:
07/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:TIME COMPLETED:
02:15 PM
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On 7/14/2022 Licensing Program Analyst (LPA) Jaylena Miller conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION. LPA met with Pooja Tibrewal facility director, also present at the time of this inspection were 8 staff and 70 children. The facility is within ratio and capacity compliance today. Upon arrival LPA provided facility representative the form LIC 125. The facility was toured to conduct a Health and Safety Inspection. This program current operates Monday-Friday 8:30am-6:00pm out of 4 classrooms; Terrific Tigers (3 yrs old), Laughing Lions (4-5 yrs old), Playful Pandas (2 yrs old) and Jungle Kids (Toddler Component 18mon-24mon).

All classrooms were inspected for age appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the cleanliness of floors and surfaces, the presence of working carbon monoxide detector, smoke detectors/fire alarms and a fully charged fire extinguishers size 2A-10-BC that are accessible throughout the facility. The bathrooms have age appropriate faucets and toilets in working condition and the jungle kids room has a diaper changing station within arm’s reach of a sink. The outdoor play area is fully fenced. There is padding under/around the climbing equipment. LPA observed the play structures to be fully intact with no visual defects or concerns. The facility does not serve food except for in emergency situations and will provide only gold fish, mac and cheese or cheerios. LPA reminded director that all food must be in original packaging or labeled with expiration date and must be checked regularly.

There are no pools, hot tubs or other accessible bodies of water. Per director, there are no firearms present on the premises. Cleaning supplies/toxins are stored inaccessible to children during the inspection and all required postings are present. The center also conducts and documents fire and earthquake drills once every 6 months and the logs show that drills were conducted on 5/25/2022.

A copy of the facility personnel roster and children’s roster were available for review and copy was obtained.

Please see LIC 809-C for continuance
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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: LITTLE HEARTS LEARNING CENTER DBA SAFARI KID
FACILITY NUMBER: 015700607
VISIT DATE: 07/14/2022
NARRATIVE
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LPA reviewed the file of 10 children enrolled in the program and 9 staff members files, who are fingerprint cleared, completion of Mandated Reporter training as well as proof of immunizations were present for 6 of the 9 staff and as a result type B deficiencies were cited, please see LIC 809-D. The opening and closing staff have current CPR/First Aid certificates that are current, and proof of education and/or experience was also present. Staff interview also conducted and documented.

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.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep web page 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. Facility representative was reminded that baby bouncers, exersaucers, johnny jumpers and similar items are not allowed in licensed day care.

Please see LIC 809-C for continuance

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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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: LITTLE HEARTS LEARNING CENTER DBA SAFARI KID
FACILITY NUMBER: 015700607
VISIT DATE: 07/14/2022
NARRATIVE
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Facility representative was reminded of the responsibility as a mandated reporter and the training's must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged facility representative to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

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.

After a complete inspection of the facility, the attached Type B deficiencies (3) were cited, please see LIC 809-D for deficiencies. 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 Pooja Tibrewal.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jaylena Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 07/14/2022 02:04 PM - It Cannot Be Edited


Created By: Jaylena Miller On 07/14/2022 at 01:40 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: LITTLE HEARTS LEARNING CENTER DBA SAFARI KID
FACILITY NUMBER: 015700607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the facility representative did not comply with the section cited above in 3 out of 9 staff did not have proof of immunizations which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/12/2022
Plan of Correction
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Facility representative will have staff provide proof of MMR, Tdap and flu vaccinations. Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the facility representative did not comply with the section cited above in 3 out of 9 staff did not have proof of completed mandated reporter training which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/12/2022
Plan of Correction
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Facility representative will have staff complete the mandated reporter training on mandatedreporterca.com. Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
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:Jaylena Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/14/2022 02:04 PM - It Cannot Be Edited


Created By: Jaylena Miller On 07/14/2022 at 01:40 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: LITTLE HEARTS LEARNING CENTER DBA SAFARI KID
FACILITY NUMBER: 015700607

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above in 2 out of 9 staff did not have a completed LIC 503 health screening which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/12/2022
Plan of Correction
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Facility representative will have both staff members schedule appointments to get completed health screenings and provide LIC 503 to facility to be placed in file. Failure to correct will result in a $100.00 per day civil penalty until corrected. Repeat violations are 250.00 per violation and $100.00 per day until corrected.
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:Jaylena Miller
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022


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