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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010200592
Report Date: 03/03/2021
Date Signed: 03/05/2021 02:05:39 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:SEQUOIA NURSERY SCHOOLFACILITY NUMBER:
010200592
ADMINISTRATOR:LORI FULLERFACILITY TYPE:
850
ADDRESS:2666 MOUNTAIN BOULEVARDTELEPHONE:
(510) 531-8853
CITY:OAKLANDSTATE: CAZIP CODE:
94611
CAPACITY:40CENSUS: DATE:
03/03/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lori FullerTIME COMPLETED:
11:15 AM
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Licensing Program Manager (LPM) Mayla Mendoza met today 3/3/21 with Director Lori Fuller and Teacher Susan Rubio for a CASE MANAGEMENT tele-visit. Center is going from Inactive to Active status. LPM virtually toured the facility and play yard for a health and safety inspection.

Physical Plant: There are no bodies of water accessible to children. Medications are kept in a safe place not accessible to children. Furniture and equipment are in good condition. The surface of the outdoor activity space is maintained in safe condition, free of hazards. Toilets, and hand washing stations are kept in a safe and sanitary operating condition. Climbing structures are cushioned with tan bark and sand. Kitchen is off limits to children. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on. The children have access to water by way of water jugs and cups. Outdoor activity space surfaces are kept free of hazards.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation has been obtained by LPA. 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 review of staff records on 3/3/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021
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: SEQUOIA NURSERY SCHOOL
FACILITY NUMBER: 010200592
VISIT DATE: 03/03/2021
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Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements was discussed today. Applicant submitted COVID-19 Self-Assessment Guide. LPM reviewed responses with applicant and provided technical assistance including postings. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

As a result of this tele-visit, there are no deficiencies cited during today's tele-visit and facility can begin active status effective today 3/3/21. This report must be available for public review for 3 years. An exit interview was conducted and a site visit notice will be posted.

SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2