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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214464
Report Date: 09/11/2019
Date Signed: 09/11/2019 02:10:22 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:FUSD - CABRILLO STATE PRESCHOOLFACILITY NUMBER:
010214464
ADMINISTRATOR:ROBERTSON, MARGARETFACILITY TYPE:
850
ADDRESS:36700 SAN PEDRO DRIVETELEPHONE:
(510) 792-3015
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:24CENSUS: 17DATE:
09/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:32 PM
MET WITH:Beverly TaubTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conduct an Annual/Random inspection. LPA met with head teacher Brenda Bethancourt. Arriving shortly thereafter FUSD Preschool Director Beverly Taub arrived. Present during today's visit were 2 staff members, 3 parent volunteers and 17 preschool aged children.

LPA conducted a health and safety inspection of the facility both inside and out. Personnel and Children's files were reviewed. The classroom and play yard were age appropriate and in good repair. Bathrooms were clean and in working order. This Title V facility operates an AM/PM session. Snacks are provided by the center. The kitchen area was maintained in a clean manner. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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 Outdoor play area was free of hazards and provided a shaded area for the children and access to drinking water. There is a working telephone at the facility. It is noted that staff members are fingerprinted and cleared by FUSD.

As a result of this visit, there are no deficiencies cited during today's visit. An exit interview was conducted and a site visit notice was posted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
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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