Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211796
Report Date: 03/06/2017
Date Signed 03/06/2017 02:55:41 PM

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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ADVENTURE TIME - CROCKER HIGHLANDSFACILITY NUMBER:
010211796
ADMINISTRATOR:WILLIAMS, JERREFACILITY TYPE:
840
ADDRESS:525 MIDCREST ROADTELEPHONE:
(510) 834-1578
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY:120CENSUS: 116DATE:
03/06/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Kit O'LearyTIME COMPLETED:
03:30 PM
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A Case Management and Annual/Random visit was conducted on this date by Licensing Program Analyst (LPA) Wynn Norona. LPA met with program supervisor, Kit O’Leary and center director, Natalie Porter. The center has applied for additional rooms to be used for the program and an increase of capacity from 120 to 200 children. The center is located inside the Crocker Highlands Elementary School. The rooms being added are (2, 4, 5, 11, 12, and the library). The center will continue to use one portable and the multipurpose room. The center is open Monday-Friday from 7am to 9am in the morning and 1pm to 6pm in the afternoon. A health and safety inspection was conducted inside and outside and the measurements are as follows:

INDOORS: EXEMPT OUTDOORS: EXEMPT

The center has obtained an approved fire clearance from the Oakland Fire Department on 2/10/17. First Aid supplies are available in the center. There is an approved waiver for individual storage bins for the children.
Facility has a functioning carbon monoxide detector. The school-age program will utilize the school’s play yard. The school yard is fenced in all around and there are climbing structures with sufficient cushion material. There is shade available for the children in the play yard. There are sinks and toilets available for children and provide privacy. The facility serves snacks and there is a microwave and refrigerator in the portable. Drinking water is available inside and outside the classrooms. This facility provides Incidental Medical Services – IMS. Ms. Kit O’Leary stated that she submitted the IMS plan of operation on the last licensing visit. LPA Norona was able to obtain and reviewed a copy of the IMS plan. The medications when dispensed are stored on a locked cabinet in the portable. Staff and children's file were reviewed so as the sign in and out logs. There are fully charged fire extinguishers all throughout the school. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and have their current immunization records on file. Opening and closing staff have current CPR/First Aid. Ms. Natalie Porter is a fully qualified director with current CPR/First Aid training. The center was found to be clean, safe, sanitary and in good repair. Zero Tolerance policies were explained. Notice of Site Visit form was provided and posted. There were no deficiencies cited during this visit. Exit interview was conducted. The director was provided a copy of the appeal rights and the signature on this form acknowledges receipt of these rights.

A license for 200 children is recommended effective today, March 6, 2017.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Wynn NoronaTELEPHONE: 510-542-4257
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2017
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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