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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070212841
Report Date: 02/12/2025
Date Signed: 02/12/2025 02:40:30 PM

Document Has Been Signed on 02/12/2025 02:40 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SRVSACCA- KIDS COUNTRY (SYCAMORE CENTER)FACILITY NUMBER:
070212841
ADMINISTRATOR/
DIRECTOR:		SHICHIDA, DANAFACILITY TYPE:
840
ADDRESS:2200 HOLBROOK DRIVETELEPHONE:
(925) 736-3638
CITY:DANVILLESTATE: CAZIP CODE:
94506
CAPACITY: 147TOTAL ENROLLED CHILDREN: 135CENSUS: 35DATE:
02/12/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Dana ShichidaTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On 02/12/2025 Licensing Program Analyst (LPA) Arminder Singh conducted an unannounced Annual/Random inspection at SRVASACCA-Kids Country (Sycamore Center),located on the premises of Sycamore Valley Elementary School. LPA met with Director, Dana Shichida and explained the purpose of today's inspection. Facility's operating days and hours are Monday thru Friday in 2 different Rooms (7am-6:30pm) and a Portable (M/T/TH/F 2:30pm-5pm and Wed 12:50pm-5pm). There is an active waiver on file for shared multi-purpose room with other community groups from 12pm-5pm M-F. Maximum Kids Country children not to exceed 32.

LPA toured the Facility both inside and outside during today's inspection with the Director. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), activity schedule, and snack menu. Children bring their own lunches to eat at facility.

LPA observed that the teacher/child ratio was in compliance during today's inspection. Facility understands the conditions, limitations, and capacity specifications of the Facility license. Facility understands that children shall be visually supervised at all times. The classrooms, restrooms, food storage areas and spaces accessible to children were inspected. Disinfectants, cleaning solutions, poisons and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Storage areas for poisons were locked and medications were kept in a safe place inaccessible to children. 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 with door locks. The portable classroom children use the elementary school restrooms. Floors were clean and free from tripping hazard. Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and rodents/vermin. 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. All toilets, hand washing areas were observed to be in safe and sanitary operating condition. All materials and surfaces accessible to children appeared to be toxic free. Menus were observed to be posted at least 1 week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days and made available upon request.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SRVSACCA- KIDS COUNTRY (SYCAMORE CENTER)
FACILITY NUMBER: 070212841
VISIT DATE: 02/12/2025
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Outdoor Space: Outdoor playground is shared with the elementary school. It was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards. Surface of the outdoor activity space was in safe condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities via water fountains.

File Review: Children sign in and out procedures and logs were reviewed. All children were signed in and in compliance with the school age sign in/out procedures. A sample of Children and Staff files was taken for review. All files contained required documents. There was at least one staff present with current certification in Pediatric CPR and First Aid at the facility during inspection. Children's Roster LIC 9040 and Personnel Report LIC500 was reviewed, and a copy obtained. Last Fire Drill was conducted January 23, 2025

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.

In the areas that were evaluated, no regulatory violations were observed.
Exit interview conducted and report was reviewed with the Director, Dana Shichida. A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Arminder Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC809 (FAS) - (06/04)
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