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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409610
Report Date: 11/05/2024
Date Signed: 11/05/2024 04:23:51 PM

Document Has Been Signed on 11/05/2024 04:23 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:SAFARI KID-WALNUT CREEKFACILITY NUMBER:
073409610
ADMINISTRATOR/
DIRECTOR:		AUTUMN CAZENASFACILITY TYPE:
860
ADDRESS:2210 OAK GROVE RDTELEPHONE:
(925) 464-7663
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 47DATE:
11/05/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Autumn CazenasTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) M. Domantay met with Director Autumn Cazenas for the purpose of a pre-licensing inspection. Applicant is requesting for a new infant program ages 0 months to 24 months (capacity 12) and decreasing the existing preschool program ages two years to first grade entry to (capacity 51) and toddler program (capacity 12) remains the same. Facility is requesting to be licensed to serve a total of 75 children. The program will operate Monday through Friday from 7:30 a.m. to 6:00 p.m. Facility does not provide food for children, all food is provided by families from home. LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA informed Autumn, that the facility will be converted to a single child care center license under facility number 073409610, therefore LPA will be closing the current preschool facility number 73408278.

The fire clearance was granted and received on 9/5/2024 from the Contra Costa County Fire Protection District for 12 infants, ages 0-24 months, 12 toddlers, ages 18-36 months, and 51 preschoolers, ages 2 years to first grade entry.

INDOOR ACTIVITY SPACE:
There are 2 indoor areas for the infant program, Infant Room 4 and Room 10 (designated crib room). LPA observed a sufficient amount of equipment, furniture, and toys. Facility plans to care for 4 crib aged infants. LPA observed 4 cribs on site. Per Director cribs will be moved to Room 10, the crib room. Medications will be stored in the Director's office in a locked drawer. LPA observed a first aid kit in the Director's office.

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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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: SAFARI KID-WALNUT CREEK
FACILITY NUMBER: 073409610
VISIT DATE: 11/05/2024
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LPA measured infant classroom. The total classroom space for the infant classroom contains a total of 386.71 square feet, which will not accommodate Applicant's request for 12 infant children.

LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. LPA observed a functional carbon monoxide detector in the facility hallway. LPA observed a electronic sign-in/sign-out system.

There is 1 sink available in the infant classroom, and a separate private restroom for the staff is located the staff room. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the Director's office and will use the staff restroom, if necessary.



OUTDOOR ACTIVITY SPACE:
LPA measured the outdoor infant program area. There is 1 infant play yard. The outdoor play area is fenced with wooden fencing that is at least four feet tall. There is turf to cushion a child's fall. LPA observed there were sufficient amount of age appropriate equipment and toys in the infant play yard. There is no play structure present in the infant outdoor play yard area. There are no bodies of water on the premises. There is sufficient shading provided by canopies and wooden awning. LPA notified Autumn that water tables must be fully emptied after every use.

The total outdoor space for the infant play yard contains a total of 1202.19 square feet, which will accommodate Applicant's request for 12 infant children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

All outdoor space for toddler and preschool measurements remain the same from previous inspections.

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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
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: SAFARI KID-WALNUT CREEK
FACILITY NUMBER: 073409610
VISIT DATE: 11/05/2024
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INDOOR ACTIVITY SPACE:
There are 7 indoor areas for the preschool program, Room 2, 3, 5, 6, 7, 8, and 9. LPA observed a sufficient amount of equipment, furniture, cots, and toys. There are 5 toilets and 6 sinks for the preschool program.

LPA measured preschool classrooms. The total classroom space for the preschool classrooms contains a total of 2556.5 square feet, which will accommodate Applicant's request for 51 preschool children.

There is 1 indoor toddler area, Room 1. All measurements remain the same for the toddler program from previous inspections.



LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Administrator any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Administrator was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.


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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SAFARI KID-WALNUT CREEK
FACILITY NUMBER: 073409610
VISIT DATE: 11/05/2024
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Administrator was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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, available at: http://www.ada.gov/childqanda.htm 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 athttps://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Director, Autumn Cazenas.

The following items are required before a license will be issued:

1. Licensing Program Manager (LPM) final file review.

2. Applicant must submit photos of infant crib room, Room 10 once it is completely set up.

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SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
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