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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710050
Report Date: 10/21/2022
Date Signed: 10/21/2022 03:01:21 PM

Document Has Been Signed on 10/21/2022 03:01 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:DUVENECK KIDS' CLUBFACILITY NUMBER:
430710050
ADMINISTRATOR:OKAMURA, JENNAFACILITY TYPE:
840
ADDRESS:705 ALESTER AVENUETELEPHONE:
(650) 328-8356
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 70TOTAL ENROLLED CHILDREN: 57CENSUS: 44DATE:
10/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jenna OkamuraTIME COMPLETED:
03:05 PM
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On October 21, 2022 at approximately 11:00am, LPA Haderer arrived unannounced for an annual inspection for compliance to Health and Safety. Present for the inspection today was the site director Jenna Okamura, three teaching staff and 2 children (pre-school age). During the inspection, and additional 42 children arrived (Kindergarten to 6th grade). The center currently operates from 8:00AM to 6:00PM M-F.

Duveneck Kid’s Club operates portable classrooms on the campus of Duveneck Elementary School. Children have use of the school yard and playground after regular school session ends. The playground has age appropriate equipment that is free of sharp, loose or pointed parts, areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. Shade is available on the property and near the school buildings. Fresh drinking water is available to children inside the classrooms and outside, teachers are always present.



The facility is clean and well organized with ample age appropriate furnishings and equipment. Surfaces including floors and counter tops are clean and toxic free. Hazardous items/toxins are kept in a locked cabinet. There are no bodies of water accessible to children in care. The center provides snacks, children bring their own lunch from home. Dry goods food was checked, everything was within the expire date, and non-fat milk in the refrigerator.

The facility has multiple fully charged 3A40BC fire extinguishers, the last annual inspections were completed on 8/09/2022. Both rooms have working smoke alarms and carbon monoxide detectors (tested and working). The fire alarm system is hardwired and will alert the fire department if activated. The last inspection was completed on 8/10/2018 and no violations were found. Disaster drills are conducted at least once every month, the last drill was conducted September 22, 2022. Heating and ventilation in the classrooms is acceptable.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2022
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: DUVENECK KIDS' CLUB
FACILITY NUMBER: 430710050
VISIT DATE: 10/21/2022
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Children use children bathrooms located in each classroom, they each have a single toilet and sink and provides privacy as required. The staff have a separate adult bathroom located in the Sun Room classroom. There was ample soap and paper towels available, all fixtures were found to be operating properly.

The sign in/out sheets were reviewed and are accurate. Classrooms have trash cans with tight fitting cover for the disposal of solid waste. There is one child that requires incidental medication (EpiPen), the medication was not expired and proper paperwork was available allowing staff to administer medication if needed.



Children's were reviewed, a facility roster was available and a photo copy taken. All files selected were complete and in good order. Staff files were reviewed. All staff subjected to criminal review have been cleared and associated to the facility. All staff have current certificates for CPR and first aid training. All records were complete and in good order.

All documents required to be posted were appropriately posted on the walls: License; Emergency Disaster Plan; Earthquake Preparedness checklist; Notification of Parents Rights; Personal rights; Child seatbelt laws; menus; daily activity schedules. There are no waivers for this facility.

Site 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 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

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: DUVENECK KIDS' CLUB
FACILITY NUMBER: 430710050
VISIT DATE: 10/21/2022
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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/inspection-process.

There were no deficiencies issued today. This report will remain on file for three years.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with site director Jenna Okamura.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC809 (FAS) - (06/04)
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