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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408201
Report Date: 11/15/2023
Date Signed: 11/15/2023 11:22:08 AM

Document Has Been Signed on 11/15/2023 11:22 AM - 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:GENIUS KIDS CLUB, THEFACILITY NUMBER:
073408201
ADMINISTRATOR:MODLIN, LINDAFACILITY TYPE:
850
ADDRESS:9000 CROW CANYON RD. #V2TELEPHONE:
(925) 309-4728
CITY:DANVILLESTATE: CAZIP CODE:
94506
CAPACITY: 21TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/15/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Kiran KhabraTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced case management inspection. This facility is currently on inactive status. Licensee plans to begin operating and requested the license to be active. The facility remains as licensed. The facility has two rooms that will be used for preschool children during the hours of 8:15 to 11:15 Monday through Friday. There are two toilets and two sinks available for the children to use. There is a separate bathroom designated for staff. There is a Heritage program in the same building. Children enrolled in the Heritage program will not be commingled with the preschool children at anytime. Bathrooms designated for preschool children will not be used by children enrolled in the Heritage program when preschool children are present. Furniture and equipment was observed to be in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the visit.

LPA reviewed required forms for staff and children files with licensee.

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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2023
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: GENIUS KIDS CLUB, THE
FACILITY NUMBER: 073408201
VISIT DATE: 11/15/2023
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

This facility does not have water outlets that are used for cooking or drinking water. Facility has bottled water delivered. Facility will request a waiver from the requirement to have the water tested for lead. Facility shall submit the request to licensing by 11/30/23.

A director packet for Lauren Taylor was provided to LPA during the visit.
The following documents are needed to complete the directors packet:
-Health Screening Report (LIC503)
-Verification of experience
-Proof of Measles immunization
Licensee agrees to submit the required documents to complete the directors packet by 11/30/23.

The facility license is will be put on active status effective today 11/15/23.
A notice of site visit was provided and must be posted for 30 days.

Exit interview conducted and report was reviewed with Kiran Khabra
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC809 (FAS) - (06/04)
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