Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013416697
Report Date: 03/29/2017
Date Signed 03/29/2017 04:20:43 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:ALA COSTA CENTERFACILITY NUMBER:
013416697
ADMINISTRATOR:COFFIELD, TANYAFACILITY TYPE:
840
ADDRESS:3390 MALCOLM STREETTELEPHONE:
(510) 383-3200
CITY:OAKLANDSTATE: CAZIP CODE:
94605
CAPACITY:50CENSUS: 11DATE:
03/29/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Tiffany OakesTIME COMPLETED:
04:35 PM
NARRATIVE
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(3) Licensing Program Analysts Belinda Devall and Sherelle Johnson met with teacher Tiffany Oakes for the purpose of an UNANNOUNCED ANNUAL VISIT. At the time of the arrival, there was an additional staff member present with a total of 6 children. Children continued to arrive and by 3:30pm, an additional staff member arrived with a total of 11 school age children present today. The facility is operating in classroom phase 3. The other two classrooms are licensed however not currently in use by the facility due to low enrollment. When the facility has increase in enrollment, they will use the other two classrooms and ensure that they are in compliance. Upon use of those classrooms, LPA will need to return to inspect those classrooms. The facility was toured to conduct a Health and Safety Inspection.

There are ample age appropriate toys that appear to be safe and in good condition. The furniture and equipment is in safe condition and is free from sharp, loose or pointed parts. All hazardous materials and toxins are kept out of the reach of children and it was observed that there are no toxins or hazardous items accessible today. All toilets, hand washing and cleaning areas are in safe and sanitary operating condition. All storage containers for solid waste has tight-fitting covers that are kept on and in good repair. All surfaces accessible to children is clean and toxic free. The sign in/out clipboard was reviewed and found to have each child present signed in/out. Uncontaminated drinking water is provided both indoors and outdoors. All staff subjected to criminal review have been cleared and associated to this facility. Staff certification in CPR and First Aid is current and valid for opening and closing staff members at this site. There was no personnel report available for review.

Due to the Director not being present to provide clarification, LPAs will return to re-review staff files, Incidental Medical Services, children's records, qualifications and ratio.

See 809-D for deficiency cited today. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and appeal rights provided and discussed.
SUPERVISOR'S NAME: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Belinda DeVallTELEPHONE: (510) 725-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2017
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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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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ALA COSTA CENTER
FACILITY NUMBER: 013416697
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/07/2017
Section Cited
101217(e)
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Personnel Records. In all cases, personnel records shall document the hours actually worked.

There was no personnel report available for review
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By 04/07/2017, Director will complete the personnel report (LIC 500) and have it readily availble for review.
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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: Ann RobinsonTELEPHONE: (510) 622-2591
LICENSING EVALUATOR NAME: Belinda DeVallTELEPHONE: (510) 725-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2017
LIC809 (FAS) - (06/04)
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