010214801-12-16-2021-52-CC-MOTI-C9RU3B-20211216141315

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010214801
Report Date: 12/16/2021
Date Signed: 12/16/2021 02:13:21 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:	EXTENDED DAY CHILD CARE - FREDERIKSEN		FACILITY NUMBER:	010214801
ADMINISTRATOR:	OCHOA, ROSAMARIA		FACILITY TYPE:	840
ADDRESS:	7243 TAMARACK DRIVE		TELEPHONE:	(925) 833-0127
CITY:	DUBLIN	STATE: CA	ZIP CODE:	94568
CAPACITY:	180	CENSUS: 0	DATE:	12/16/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	01:02 PM
MET WITH:	Vanessa Sinclair		TIME COMPLETED:	02:22 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	A Case Management Visit was conducted on this date 12/16/2021 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA met with Executive Director, Vanessa Sinclair. An application was submitted for an Addition of Room. The center has requested to add a new PORTABLE BUILDING with TWO CLASSROOMS as licensed space. The school age program is located on Frederiksen Elementary School campus. The program is currently utilizing the MULTI PURPOSE ROOM on school grounds. Facility's previous portable building will now be demolished due to construction occurring on campus. Hours of operation are from 7:00AM to 6:00PM, Monday through Friday. Present today were 9 staff members and no children. A health and safety inspection was conducted inside and outside. INDOORS: EXEMPT OUTDOORS: EXEMPT Facility utilizes the KINDERGARTEN playground and blacktop. Drinking water is available inside and outside by way of water fountains and bottles brought from home. Facility provides AM/PM snacks. Menus are posted. Lunch is brought from home. Facility has a functioning carbon monoxide detector, smoke detector and fire extinguisher. Facility has a sign in/out sheet that allows ample space for full legal signature and records time and date. An approved Fire Clearance was received on 12/16/2021 from Dublin Fire Prevention for 180 school aged children. All licensing required documents are posted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: EXTENDED DAY CHILD CARE - FREDERIKSEN	FACILITY NUMBER: 010214801
	VISIT DATE: 12/16/2021

NARRATIVE

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Per Director, all Opening and Closing staff have current Pediatric CPR/First Aid. Playground equipment is in good condition. This facility plans to provide Individual Medical Services – IMS. An updated Plan of Operation that includes IMS must be submitted to the Department when any changes are made. 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.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Director is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

Zero Tolerance policies were explained.
The center was found to be clean, safe, sanitary and in good repair.

There are no deficiencies cited during today's visit. A license with approval for 180 school aged children operating out of the new portable with two classrooms, and the multi-purpose room will be issued effective today, 12/16/2021.

An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC809 (FAS) - (06/04)

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