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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212589
Report Date: 05/26/2022
Date Signed: 05/26/2022 12:56:41 PM


Document Has Been Signed on 05/26/2022 12:56 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:FREMONT CHRISTIAN PRESCHOOLFACILITY NUMBER:
010212589
ADMINISTRATOR:JIMENEZ, NATHANIELFACILITY TYPE:
850
ADDRESS:4760 THORNTON AVENUETELEPHONE:
(510) 744-2260
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:197CENSUS: 12DATE:
05/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Nathaniel JimenezTIME COMPLETED:
01:00 PM
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On May 26, 2022 at approximately 11:45am, LPA Haderer arrived unannounced for a Case Management visit to meet with center director Nathaniel Jimenez.

The purpose of the visit was to follow up on an unusual incident filed on April 8, 2022. The incident occurred on April 7, 2022 at approximately 9:20am involving a 2 1/2 year old child found alone in a classroom.

LPA Haderer conducted interviews with the center director, the teacher of room P6 (where the child was found), the assistant floater that was there helping that morning, and the mother of the child (who happens to teach at the elementary school next door.)

Due to time constraints, LPA will compile all the interview notes and follow up with the center director on any next steps.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022
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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