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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214464
Report Date: 03/27/2025
Date Signed: 03/27/2025 12:21:39 PM

Document Has Been Signed on 03/27/2025 12:21 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:FUSD - CABRILLO STATE PRESCHOOLFACILITY NUMBER:
010214464
ADMINISTRATOR/
DIRECTOR:		BRENDA BETHANCOURTFACILITY TYPE:
850
ADDRESS:36700 SAN PEDRO DRIVETELEPHONE:
(510) 792-3015
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 22DATE:
03/27/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:58 AM
MET WITH:Brenda BethancourtTIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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On March 27, 2025, at 8:58am, Licensing Program Analyst (LPA) Randy Miranda arrived for an unannounced visit for a required 1-year inspection of this Title V campus. LPA met with the site supervisor, Brenda Bethancourt. Present for today's inspection was the site supervisor, two teachers, and 22 preschool children. The center is in compliance with teacher/child ratios required under Title V. Hours of operation are Monday – Friday 8:30am to 11am and 12:10pm to 3:30pm.

The facility is clean and well organized with age-appropriate furnishings and equipment in good repair. Surfaces including floors and counter tops are free of hazards and toxins. There is a working carbon monoxide (tested and functioning) and smoke detectors in the ceilings of the classroom. A class 3A40BC fire extinguisher is located next to the main entrance door. Fire extinguisher inspection last conducted by the State Fire Marshall on 07/25/2024. Fire alarm system and smoke detectors were last inspected by Fremont Fire Department on 03/24/2025.

The classroom has ample age-appropriate toys that appear to be safe and in good condition. There are no bodies of water accessible to children in care. There are cubbies available for all children's personal possessions. Children in care do not take naps at the facility.

Outside play area is shared with the kindergarten school. There are two waivers posted, 1.) to ensure a schedule is maintained limiting the number of children in the play area at the same time and 2.) allow the children to use the elementary school bathrooms as long as the children are accompanied by facility staff and no elementary children are present. LPA observed holes/divots in the grassy section of the outside play area. LPA reminded site supervisor to have school maintenance fill in the holes/divots

Wynn NoronaTELEPHONE: (510) 421-1324
Randy MirandaTELEPHONE: (510) 359-0974
DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: FUSD - CABRILLO STATE PRESCHOOL
FACILITY NUMBER: 010214464
VISIT DATE: 03/27/2025
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There is a perimeter fence protecting the children from leaving the area. All play equipment is in safe condition and free from sharp, loose, or pointed parts and the areas around or under high climbing equipment has appropriate cushioned material that absorbs a fall. Shade and drinking fountains are available in the play area. Teachers supervise children at all times in the play area.

All required posted documents were present. Disaster/fire drills are conducted monthly by the main school, the last drill was conducted on 03/17/2025. The classroom has two separate bathrooms with hot and cold running water. One bathroom is for the children (located next to the classroom sink), the other one is for staff (located nearest the playground entrance). All toilets, handwashing and cleaning areas are in safe and sanitary operating condition. Trash bins were covered with tight fitting lids and all surfaces accessible to children are clean and toxic free. The sign in/out process is electronic. The process was reviewed, and all children were properly signed in and accounted for. The snack menu is posted and visible for review. All food/snacks were within expiration date.

LPA reviewed children's records: LPA requested and reviewed the facility roster; a copy was taken. All other files selected and reviewed were complete, up to date, and found to be in compliance with Title 22 and Title V regulations.

LPA reviewed staff files. All files were complete, up to date, and found to be in compliance with Title 22 and Title V regulations. Site director’s 1st aid/CPR expires on 03/28/2026 and Mandated Reporter Certificate expires on 08/16/2026. LPA reminded site supervisor of the following: Mandated Reporter training (AB1207) and CPR/First Aid must be renewed every two years.

Site supervisor was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Randy MirandaTELEPHONE: (510) 359-0974
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: FUSD - CABRILLO STATE PRESCHOOL
FACILITY NUMBER: 010214464
VISIT DATE: 03/27/2025
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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). Children bring their own water bottles and the school also provides access to water fountains to children. Lead testing is complete and posted for viewing.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies and observed one of the epinephrine auto injectors did not contain the original box, however printed prescription matched the epinephrine auto injector. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

There were no deficiencies found during today’s inspection.

A notice of site visit was given and must remain posted for 30 days. Appeal Rights provided.

Exit interview conducted and report was reviewed with the site supervisor Brenda Bethancourt.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Randy MirandaTELEPHONE: (510) 359-0974
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC809 (FAS) - (06/04)
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