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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408800
Report Date: 04/25/2023
Date Signed: 04/25/2023 02:49:23 PM

Document Has Been Signed on 04/25/2023 02:49 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 SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HOOVER KIDS' CLUBFACILITY NUMBER:
434408800
ADMINISTRATOR:MOUTAL, NATHALIEFACILITY TYPE:
840
ADDRESS:445 EAST CHARLESTON ROADTELEPHONE:
(650) 565-8847
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
04/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Nathalie Moutal- DirectorTIME COMPLETED:
03:00 PM
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On 4/25/23 at 1:18pm, Licensing Program Analyst (LPA) Briana Plumboy arrived to the facility unannounced to conduct a REQUIRED 1 YEAR inspection. LPA was met by Director Nathalie Moutal. Present during today's visit was 4 staff members. LPA conducted a health & safety inspection inside and outside upon arrival with Director Nathalie Moutal. Hoover Kids' Club is located inside 2 portables near the large grass area on the Hoover Elementary School Campus.

LPA observed disinfectants, cleaning solutions and other items which are dangerous to children are kept inaccessible to children in care during today's inspection. Furniture and playground equipment are in good condition, free of sharp, loose or pointed parts during today's inspection. Surface areas of outdoor activity space are maintained. Toilets and hand washing facilities are in safe and sanitary operating condition during today's inspection. Storage containers for solid waste had tight-fitting covers that were kept on and in good repair during today's inspection. Drinking water is readily available both inside and outside. Carbon Monoxide detector, smoke detector, and fire extinguishers were observed to be in operable condition.

Record review indicates that all staff present during today's visit have the proper criminal record clearance/exemption on file. At least on person trained in CPR and Pediatric First Aid is present while children are in care. Personnel files contained a health screening. Required personnel have current mandated reporter training and current immunization's on file. Menus were observed to be posted at least on week in advance in a place visible by the child's authorized representative. The last earthquake drill was conducted on 4/4/23 and the last fire drill was conducted on 2/28/23. LPA Plumboy received a copy of the current LIC 500 (Personnel Roster) and LIC 9040 (Child Care Facility Roster).
See 809-C for second page of report....
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2023
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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HOOVER KIDS' CLUB
FACILITY NUMBER: 434408800
VISIT DATE: 04/25/2023
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Facility representative 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.

Director is reminded that unusual Incidents must be reported within 24 hours by phone. Written report is to follow within 7 days utilizing form LIC624. LPA informed the Director that all forms can be downloaded at www.ccld.ca.gov and encouraged the Director to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Director was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

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

A notice of site visit was given and must remain posted for 30 days. Appeal rights provided. Exit interview conducted and report was reviewed with the Director Nathalie Moutal.


An exit interview was conducted with Director, Nathalie Moutal.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC809 (FAS) - (06/04)
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