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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010206131
Report Date: 08/18/2022
Date Signed: 08/18/2022 02:07:38 PM


Document Has Been Signed on 08/18/2022 02:07 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, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:OUSD - HINTIL KUU CAFACILITY NUMBER:
010206131
ADMINISTRATOR:JONES, CAROLINEFACILITY TYPE:
850
ADDRESS:11850 CAMPUS DRIVETELEPHONE:
(510) 879-0840
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:42CENSUS: 28DATE:
08/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sharon TraversTIME COMPLETED:
02:00 PM
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On 8/18/22 at 1:00 pm, Licensing Program Manager (LPM) Loretta Dyson arrived at the facility for a case management inspection. LPM met with Sharon Travers, Early Learning Principal/Site Administrator. A request was received to have an inspection of the new playground equipment that was recently installed, so that it can be approved for use by children. There were 28 children and 9 staff also present.

LPM conducted a tour of the outdoor space that now includes the new playground equipment. The outdoor space is in the center courtyard between the classrooms. LPM inspected the equipment and found that it is anchored, has sufficient cushioning underneath to absorb a fall, and appears to be safe and free of defects. The manufacturer’s label indicates that the equipment is appropriate for children ages 2-5 years, with sufficient strength and coordination and adult supervision. The outdoor space is surrounded by a fence that is at least 4 feet high. LPM did not observe any defects or dangerous conditions in the rest of the outdoor space. LPM observed that there is shade from the building overhang, trees, and in the space underneath the playground equipment. Sharon Travers confirmed that the square footage of the outdoor space has not changed.

The playground equipment and outdoor space is approved for use for children, and is able to be used by the facility whenever they are ready.

There are no deficiencies being cited today. An exit interview was conducted with Sharon Travers. A copy of the report, appeal rights, and Notice of Site visit were emailed to Sharon Travers.

SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2022
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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