<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010210783
Report Date: 01/23/2023
Date Signed: 01/23/2023 12:22:55 PM


Document Has Been Signed on 01/23/2023 12:22 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 STE 1102
OAKLAND, CA 94612



FACILITY NAME:RESURRECTION LUTHERAN PRESCHOOLFACILITY NUMBER:
010210783
ADMINISTRATOR:WAZHMA MASARWEHFACILITY TYPE:
850
ADDRESS:7557A AMADOR VALLEY BOULEVARDTELEPHONE:
(925) 829-5487
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:80CENSUS: DATE:
01/23/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Director, Wazhma MasarwahTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On Monday 01/23/2022 at approximately 11:00 am, Licensing Program Analyst (LPA) Jyoti Saini, Licensing Program Manager (LPM) Wynn Norona, and Regional Manager (RM) Anika Evans conducted an Announced Office Meeting with Director Wazhma Masarweh and assistant director Erika Hidley. The purpose of this meeting was to discuss the waiver request, incident reports, and water damage that have impacted the facility.

During the meeting, LPM Norona gathered information about the temporary relocation area and worked with the director on the plan for the children’s bathroom. LPM Norona discussed the supporting documents to request the fire clearance. During the meeting, the Regional manager( RM), Anika Evan, advised the facility to use the Narthex area as a field trip only and also reminded the facility about the reporting requirement and suggested that the facility notify the department before changes occurred.

An exit interview was conducted with the director, and a copy of the report was given to the facility representative, Wazhma Maserwah.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1