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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408916
Report Date: 08/23/2024
Date Signed: 08/23/2024 04:26:25 PM

Document Has Been Signed on 08/23/2024 04:26 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:HEADSUP! CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434408916
ADMINISTRATOR/
DIRECTOR:
BARBERIS, VITTORIAFACILITY TYPE:
830
ADDRESS:2800 WEST BAYSHORE ROADTELEPHONE:
(650) 424-1221
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 8DATE:
08/23/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Chuck BernsteinTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
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On 08/23/2024 at 9:15am, Licensing Program Analysts (LPAs) Jialing “Julianne” Zhu and Christina Uribe met with licensee, Chuck Bernstein, for an unannounced annual continuation inspection. The initial annual inspection was conducted on 08/22/2024 but was not completed due to time constraints. A report was written for the initial inspection – See LIC 809. Today’s report is written with information obtained through observations, interviews, and record review from the initial annual inspection and today’s continuation inspection. Present during today’s inspection were licensee, three (3) fingerprint-cleared staff, and eight (8) infants in care. The facility was toured to conduct a Health and Safety Inspection. The facility’s current hours of operation are Monday - Friday from 8:00am - 6:00pm. The facility shares a campus with a preschool component. The facility has an indoor and outdoor space for infants that is physically separate from space used by the preschool component (434408915).

Classroom: This facility has one (1) classroom licensed for the infant component, Room 1. The inside of the classroom is divided into seven (7) areas by shelfs and baby gates: nap room for younger infants (with door), nap area for toddlers, main play and learning area, alternate play and learning area, food prep area, dining area, and changing table. The isolation area is the food prep area or a section of the classroom, away from other children in care.

The classroom was inspected for age-appropriate furnishings, equipment, & adequate storage for children’s belongings. LPA observed the cleanliness of floors & surfaces, the presence of a fully functional carbon monoxide detector and fully charged 3A40BC fire extinguishers is accessible throughout the facility. The smoke detectors were not tested during today’s inspection. First aid supplies are available in the classroom, inaccessible to children. LPA inspected the napping equipment and observed them to be stored in a healthful manner. On 08/22/2024 and 08/23/2024, LPA observed 1 infant sleeping with a sleep sack during nap time. The infant changing tables are placed within arm’s reach of a sink while in use. There are trash cans with tight-fitting lids located throughout the facility. Children’s medications are stored in a lock box located in an upper cabinet in the food prep area. Drinking water is accessible by children in the classroom. Disinfectant and other cleaning supplies are made inaccessible to children in care. LPA observed no fireplaces or wall heaters at the facility. Page 1 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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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Document Has Been Signed on 08/23/2024 04:26 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Jialing Zhu On 08/23/2024 at 01:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HEADSUP! CHILD DEVELOPMENT CENTER

FACILITY NUMBER: 434408916

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 08/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Under Appeal
Type A
Section Cited
CCR
101429(a)(1)
Responsibility for Providing Care and Supervision for Infants
(1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. Under no circumstances shall ANY infant be left unattended.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews, the licensee did not comply with the section cited above as 2 staff members stated an infant was left unattended in the outdoor play area on the morning of 08/22/2024, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/26/2024
Plan of Correction
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Licensee and all staff will conduct a meeting to create a plan to ensure all infants in care will be supervised at all times. Licensee will submit the written plan with signatures of all staff members acknowleging their understanding and cooperation to LPA at jialing.zhu@dss.ca.gov by 4:00pm on Monday, 08/26/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Jialing Zhu
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 08/23/2024 04:26 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Jialing Zhu On 08/23/2024 at 01:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HEADSUP! CHILD DEVELOPMENT CENTER

FACILITY NUMBER: 434408916

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 08/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Under Appeal
Type B
Section Cited
CCR
101430(a)(3)(C)
Infant Care Activities
(C) An infant shall not be swaddled while in care.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above as 1 infant (under 12 months of age) was sleeping with a sleep sack on during nap time. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/06/2024
Plan of Correction
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Licensee will conduct an all staff training regarding Safe Sleep regulations. Licensee will create a written statement acknowlegding the requirement than no infant shall be swaddled in care, which includes sleep sack. All staff will sign the written statement. Licensee will send signed written statement to LPA at jialing.zhu@dss.ca.gov by 09/06/2024.
Type B
Section Cited
CCR
101416.5(b)
Staff-Infant Ratio
(b) There shall be a ratio of one teacher for every four infants in attendance.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as 0 of the 3 staff members present during today's inspection is a fully qualified infant teacher, thus the facility is out-of-ratio, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/06/2024
Plan of Correction
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Licensee will create a written plan to ensure at least one fully-qualified infant teacher is in the classroom according to staff-infant ratio regulations. Licensee will email written plan to LPA at jialing.zhu@dss.ca.gov by 09/06/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Chandra Charles
LICENSING EVALUATOR NAME:Jialing Zhu
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024


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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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HEADSUP! CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434408916
VISIT DATE: 08/23/2024
NARRATIVE
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Food Service Areas: LPA observed a food preparation sink in Room 1 and is separate from the changing table sink. Food prep area is clean, adequately equipped, and free from hazardous materials. There is a refrigerator for the storage, preparation and service of food or snacks. Parents will provide meals for the infants, and the center provides AM/PM snacks. All facility-provided food items are properly labeled and stored separately from cleaning supplies. Bottles, dishes, and containers of food brought by the infants’ authorized representatives are labeled with infant’s name. Snack menus are posted and were reviewed. LPA observed the snack menu for the current week is incomplete as the snacks for 08/20/2024, 08/22/2024, and 08/23/2024 was not filled in.

Bathrooms: There are no bathrooms located in the infant component, but a changing table is available in Room 1. Staff have separate bathrooms from the children which are located in the hallway.

Outdoor Play Area: The outdoor play space is fully fenced. The surfaces are free from hazards. There is ample shade available. There are age-appropriate outdoor toys and materials for the children. There are no play structures or climbing apparatuses in the outdoor play space. The ground is sufficiently padded with interlocking foam mats and is in good condition. LPA observed two play areas with sand and are free from hazards. There are no pools, similar bodies of water, or free-standing water on premises.

Records: All individuals subject to criminal record review have a clearance and/or exemption and have been associated to the facility. LPAs reviewed eight (8) children’s files. Record review of children’s file revealed 1 of 8 infants need an updated Needs and Services Plan, 2 infant's medication need new LIC 9221 OR returned to parents because the LIC 9221s have end dates that have already passed, and 4 of 8 infants’ immunization records need to be update. LPAs reviewed eight (8) staff files. Record review of staff files revealed 2 of 8 staff have TB test results that are older than 12 months prior to initial employment at the facility, and 3 of 8 staff are fully qualified infant teachers. During today’s inspection, 3 aides were providing care and supervision but was not under the direct supervision of a fully qualified teacher, thus the facility is out-of-ratio.

LPA reviewed the facility roster & personnel report and copies were obtained. At least one opening/closing staff member has a current Pediatric CPR/First-Aid Certification. Mandated Reporter certificates were reviewed and are current. The facility utilizes an electronic sign-in/out application. LPA requested and obtained a sample of printouts of digital sign-in/out sheets from 07/29-08/02/2024. LPA observed on 07/29/2024, 1 infant was signed out through a staff's account and did not have a parent signature. Emergency Disaster Drills are performed at least every six months, and the last drill was conducted on 05/21/2024. Per owner, there are no firearms on the premises. All required documents are posted in a publicly accessible area. Page 2 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
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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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HEADSUP! CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434408916
VISIT DATE: 08/23/2024
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LPAs also conducted interviews with staff. 2 staff members stated an infant was left unattended in the outdoor play area on the morning of 08/22/2024.

Record Keeping and Reporting Requirements: Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Personnel and facility roster must be properly maintained, and fire/disaster drills must be conducted at least every six (6) months and documented. Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within seven (7) business days. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov.

Criminal Record Clearance: Facility representative was reminded that all adults 18 and over, 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.

Lead Testing: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. LPA referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS): This facility does provide Incidental Medical Services (IMS). LPA inspected storage of medications and equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA reminded owner all children’s medications must be securely stored, accompanied by their original packaging, and are in compliance with expiration dates. For IMS information see PIN 22-02-CCP. 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/resources/child-care-centers/. Page 3 of 4. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
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 SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: HEADSUP! CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434408916
VISIT DATE: 08/23/2024
NARRATIVE
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CCLD Information and Updates: 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 platforms. 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.
Three (3) deficiencies and six (6) technical violations (TV) were issued during today’s inspection. Note that technical violations are not citations but are advisory notes.

Type A Deficiency: (A copy of this report and LIC 9224 Acknowledgment of Receipt of Licensing Reports must be signed by parents and kept in children's files.)

· 1 infant was left unsupervised in the outdoor play area.

Type B Deficiencies:

· 1 infant was napping with a sleep sack

· Facility is out of ratio during today’s inspection since there was no fully-qualified infant teacher present.

Advisory Notes (TV):

· Snack menu is incomplete

· 1 infant was no correctly signed out on 07/29/2024

· 1 infant’s Needs and Services Plan needs to be updated

· 2 infants’ medication with LIC 9221s have end dates that have already passed

· 4 of 8 infants’ immunizations need to be updated

· 2 staff members’ TB test results are older than 12 months prior to employment at the facility

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with licensee, Chuck Bernstein. LPA provided licensee a copy of the Appeal Rights.

Page 4 of 4. End of Report.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC809 (FAS) - (06/04)
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