070208893-1-20-2023-02-CC-MMAR-CN9UC6-20230120142726

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 070208893
Report Date: 01/20/2023
Date Signed: 01/20/2023 02:27:34 PM

Document Has Been Signed on 01/20/2023 02:27 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:	SRVSACCA - KIDS COUNTRY-VISTA GRANDE		FACILITY NUMBER:	070208893
ADMINISTRATOR:	GRAVELYN, JEANETTE		FACILITY TYPE:	840
ADDRESS:	667 DIABLO ROAD		TELEPHONE:	(925) 837-0330
CITY:	DANVILLE	STATE: CA	ZIP CODE:	94526
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 111	CENSUS: 24	DATE:	01/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Ann Tancioco		TIME COMPLETED:	03:00 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 1/20/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Annual Inspection at SRVSACCA Kids Country Vista Grande. Director, Jeannette Gravelyn was not present today and LPA met with Executive Director, Ann Tancioco. Facility is located in the premises of Vista Grande Elementary School. Facility's operating days and hours are Monday to Friday from 7 am - 6 pm in 2 Rooms - Bigs and Littles. There is an active waiver on file for use of electronic sign in system. The physical plant was inspected. LPA toured the premises with Ann Tancioco. Indoor space: Classrooms, restrooms were inspected. There were 2 staff with 10 children present at time of inspection. Facility was in compliance with teacher child ratios during inspection. Children were engaged in various activities under the visual supervision of the teachers. Disinfectants, cleaning solutions, and other items dangerous to the health and safety of children were stored in places inaccessible to them. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Foods and beverages were stored safely. Trash cans for solid waste had tight-fitting covers on and were in good repair. LPA observed a working Fire extinguisher, Smoke and Carbon Monoxide Detectors. Log shows that the last Fire Drill was conducted on 1/19/23. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles. Required postings were observed to be posted. Outdoor space was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. Shade is provided and there were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

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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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: SRVSACCA - KIDS COUNTRY-VISTA GRANDE	FACILITY NUMBER: 070208893
	VISIT DATE: 01/20/2023

NARRATIVE

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File Review: Children sign in and out procedures and logs were reviewed. A sample of children and staff files was taken for review. All files contained required documents. There was at least one teacher with current certification in Pediatric CPR/First Aid present at the facility during inspection. Children's Roster was reviewed

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

Director 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.

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.

There were 24 children with 8 staff by end of inspection.

In the areas that were evaluated, no regulatory violations were observed.
Exit interview conducted and report was reviewed with the Executive Director, Ann Tancioco and Assistant Director, Katie Whitehouse. A NOTICE OF SITE VISIT was given and must remain posted for 30 days.

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023

LIC809 (FAS) - (06/04)

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