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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070209916
Report Date: 06/09/2023
Date Signed: 08/03/2023 02:09:13 PM

Document Has Been Signed on 08/03/2023 02:09 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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SRVSACCA - KIDS COUNTRY-JOHN BALDWINFACILITY NUMBER:
070209916
ADMINISTRATOR:ELIZABETH CASTILLOFACILITY TYPE:
840
ADDRESS:741 BROOKSIDE DRIVETELEPHONE:
(925) 831-3530
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY: 128TOTAL ENROLLED CHILDREN: 128CENSUS: 47DATE:
06/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jessica BannisterTIME COMPLETED:
03:30 PM
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On June 9, 2023, Licensing Program Analyst (LPA) Simerjit Kaur conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION for School Age component and met with site director Jessica Bannister. The facility is located on the campus of John Baldwin Elementary School. The facility was toured to conduct a Health and Safety Inspection. There were 10 staff members and 47 children present during the inspection. The facility is within ratio and capacity compliance today. The facility operates Monday - Friday from during summer 7:30am - 6:00pm and school year 7:00 am - 6:30pm.

This component operates out of classrooms Littles and Bigs. There are adequate play and learning materials available. Furniture and equipment is age appropriate and in good repair. There is adequate heating, ventilation and lighting. There is individual storage space for each child. All storage areas and cabinets for poisons are locked. There are working carbon monoxide detectors in each classrooms, fire extinguisher and a pull down alarm device. The smoke detectors are connected with San Ramon School District.

There are separate bathrooms for staff and the children. The bathrooms for children are located in the hallway between the 2 classrooms. Toilets and faucets working properly. Adequate lighting is provided in all bathrooms. All required postings are posted. The facility serves AM/PM snacks. The menu is also posted for review. Drinking water is available inside and outside.

There are age appropriate play equipment, and materials for the school age children. The first aid kit is available in the classroom. Sign-in and sign-out logs were reviewed to verify signatures. LPA reviewed staff files and children files. All opener and closer of facility have CPR and First Aid certificates.


See LIC 809 C
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2023
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
BAY AREA-CC OAKLAND, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SRVSACCA - KIDS COUNTRY-JOHN BALDWIN
FACILITY NUMBER: 070209916
VISIT DATE: 06/09/2023
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All required forms were posted in a public accessible area. Per director there are no firearms on the premises. A copy of the children’s roster and facility roster was obtained.

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.

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 Center 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 is encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.




A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023
LIC809 (FAS) - (06/04)
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