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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010205821
Report Date: 01/07/2022
Date Signed: 01/07/2022 11:08:50 AM

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:VALLEY CHRISTIAN PRESCHOOLFACILITY NUMBER:
010205821
ADMINISTRATOR:JARIN, RINAFACILITY TYPE:
850
ADDRESS:7500 INSPIRATION DRIVETELEPHONE:
(925) 560-6235
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:132CENSUS: 42DATE:
01/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rina JarinTIME COMPLETED:
11:30 AM
NARRATIVE
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On 1/7/2022 at 9:00am Licensing Program Analysts (LPAs) Jaylena Miller and Christina Uribe conducted a subsequent case management inspection.

LPAs reviewed an email that was sent to preschool parents on 12/20/2021 revealing a positive COVID and those who were present on 12/15/2021 and 12/17/2021 were “possibly exposed”. LPAs checked FAS and the facility did not report an Unusual Incident Report for the positive COVID on 12/20/2021. As a result, and Per California Code of Regulations, Title 22, Division 12, Chapter 1 Section 101212(d)(1)(E) is being cited. Please see LIC 809-D for deficiency.

Exit interview conducted. Notice of site visit given and must be posted for 30 days. A copy of this report and appeal rights were given to director, Rina Jarin.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jaylena MillerTELEPHONE: (510) 292-8297
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
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: VALLEY CHRISTIAN PRESCHOOL
FACILITY NUMBER: 010205821
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/07/2022
Section Cited

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Reporting Requirements 101212(d)(1)(E)
Upon the occurrence, during the operation of the child care center of any of the events specified in... Events reported shall include the following: (E) Epidemic outbreaks.
This was not met as evidence by:
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Based on observation, interviews and record review the facility did not report to licensing within 24 hours that the facility had a positive covid on 12/20/2021 which poses a potential risk to the health safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jaylena MillerTELEPHONE: (510) 292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2022
LIC809 (FAS) - (06/04)
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