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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414438
Report Date: 08/25/2022
Date Signed: 08/25/2022 02:44:54 PM

Document Has Been Signed on 08/25/2022 02:44 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:EDGEWOOD HOUSE PRESCHOOL LLCFACILITY NUMBER:
434414438
ADMINISTRATOR:GRANILLO, J/BROWN, MFACILITY TYPE:
850
ADDRESS:493 W. CHARLESTON ROADTELEPHONE:
(650) 690-2347
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 24TOTAL ENROLLED CHILDREN: 23CENSUS: 16DATE:
08/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mallory Brown and Janessa GranilloTIME COMPLETED:
02:55 PM
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On August 25, 2022 at approximately 9:30am, LPA Haderer arrived unannounced for an annual inspection for compliance to Health and Safety. The new CARE tool was used for the inspection. Present for the inspection was the site director Mallory Brown, 5 teachers and 16 children in care. The facility is in ratio today.

The facility has is a single-story building with 4 distinct indoor areas for children (Library; building room; dramatic play; and napping room). There is a children’s bathroom with 2 small toilets, and a sink basin with 2 faucets; a fenced front yard with a shaded garden area with tables, chairs a playhouse and sandbox; a large fenced backyard area with a play structure, sandbox and shaded area for activities. LPA observed that both the learning and play areas are in safe condition and free from sharp, loose or pointed parts and the areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. The children are supervised at all times when playing outside.



Off limits to children is the small kitchen, laundry room; staff bathroom; and basement staff breakroom, office and storage room. Off limits areas inaccessible by closed and/or locked doors, and/or by child supervision. Sharp objects (knives, scissors) are kept in the off-limits kitchen and out of reach from the children. All disinfectants and cleaning solutions are stored in the top cabinets, out of the reach of children.

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. The school follows proper Covid-19 protocols, parents and visitors are not allowed, children and staff are all wear face coverings. Hazardous items/toxins are kept out of the access of children. There are no bodies of water accessible to children in care. The facility provides snacks for the children. Milk for the children was 2%, however, for children over 2 years of age, only 1% or non-fat may be served. A Technical Violation (not a deficiency) was issued.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2022
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: EDGEWOOD HOUSE PRESCHOOL LLC
FACILITY NUMBER: 434414438
VISIT DATE: 08/25/2022
NARRATIVE
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The facility has two fully charged 2A10BC and one 3A40BC fire extinguishers. The 3A40BA extinguisher is located in the kitchen area; one 2A10BC located near the children’s bathroom; one 2A10BC is in the basement. Arrow Fire Protection Services does annual fire inspections, the last inspection was completed on 9/17/2021. Carbon monoxide and smoke detectors were available, tested and functioning. Heating and ventilation is acceptable. Disaster drills are done at least once every six months, the last drill was conducted 8-1-2022.

Sign in/out sheets are done manually. Parents meet teachers at the front gate by the front garden area to sign their children in and out. Temperature checks are made on the children to ensure no fevers. All children signed in were present and accounted for.



Throughout the facility there are trash cans with tight fitting covers for the disposal of solid waste. All required posters are present, License; Parents Rights; Personal Rights; Emergency Disaster Plan; Seatbelt Laws poster; and drawing of facility sketch. Children’s bathroom has enough towels and soap supplies. The staff have separate adult bathroom located in the off limits kitchen area. There are sleeping mats with the crib sheets for napping children. The sheets are washed daily by the facility in the laundry room located inside the facility. The facility provides snacks, children bring their own lunch and bottled water to school. Access to clean bottled drinking water is available.

Staff files were reviewed. One staff member’s file was missing immunization records and a Health Screening report see LIC809D for deficiency. All staff are all up to date with CPR/1st Aid certificates and non-expired Mandated Reporter certificates. All staff subjected to criminal review have been cleared and associated to the facility.

Children's records were reviewed: LPA requested and reviewed facility roster, a photo copy was made for the office file. Two children require EpiPens, however, LIC9221 Parent Consent for Administration of Medications forms were not filled out and signed by the parents see LIC809D for deficiency. One child had over-the-counter antihistamine available, however no signed form from the parents was available. A Technical Assistance (not a deficiency) was issued. All other records were complete and in good order.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
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: EDGEWOOD HOUSE PRESCHOOL LLC
FACILITY NUMBER: 434414438
VISIT DATE: 08/25/2022
NARRATIVE
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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

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.

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 3 deficiencies issued today, see LIC809D. A Technical Violation and a Technical Assistance (not deficiencies) were also issued. This report will remain on file for 3 years.

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



Exit interview conducted and report was reviewed with the Site Director Janessa Granillo.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7
Document Has Been Signed on 08/25/2022 02:44 PM - It Cannot Be Edited


Created By: Russell Haderer On 08/25/2022 at 01:56 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: EDGEWOOD HOUSE PRESCHOOL LLC
FACILITY NUMBER: 434414438

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 1 out of 6 staff member's file did not contain proof of immunization for measles and pertussis which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/02/2022
Plan of Correction
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Staff member to obtain medical records showing proof of immunization. Going forward, childcare center will ensure all staff records are complete including immunization records.
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that one out of 6 staff member's file did not contain a LIC503 Health Screening report from a physician, including the TB test result which poses a potential health, safety or personal rights risk to persons in care. All other staff files were complete and in good order.
POC Due Date: 09/02/2022
Plan of Correction
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Staff member to obtain medical screening (including proof of negative TB test). Going forward, childcare center will ensure all staff records are complete including Health Screening reports.
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:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2022


LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 08/25/2022 02:44 PM - It Cannot Be Edited


Created By: Russell Haderer On 08/25/2022 at 01:56 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: EDGEWOOD HOUSE PRESCHOOL LLC
FACILITY NUMBER: 434414438

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(3)(B)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 2 of 21 children require EpiPens. Non-expired medications were available and stored safely, however, LIC9221 Parent Consent for Administration of Medications forms were not filled out and signed by the parents which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/02/2022
Plan of Correction
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Center director will obtain completed and signed LIC9221 forms from the parents and maintain these forms with a Plan of Action for the children.
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:Russell Haderer
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2022


LIC809 (FAS) - (06/04)
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