010215763-8-6-2021-52-CC-MOTI-C5MQK4-20210806121343

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010215763
Report Date: 08/06/2021
Date Signed: 08/06/2021 12:13:51 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:	HOLY SPIRIT PRESCHOOL		FACILITY NUMBER:	010215763
ADMINISTRATOR:	TARRANT, CECILIA		FACILITY TYPE:	850
ADDRESS:	3930 PARISH AVENUE		TELEPHONE:	(510) 793-2013
CITY:	FREMONT	STATE: CA	ZIP CODE:	94536
CAPACITY:	36	CENSUS: 0	DATE:	08/06/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Cecelia Tarrant		TIME COMPLETED:	09:42 AM

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	Licensing Program Analyst (LPA) Melanie Otsuji conducted an unannounced Case Management Inspection. LPA was met by Director, Cecelia Tarrant. Facility is currently on summer break and facility will resume their Fall session on August 18, 2021. The center has submitted an application for a ROOM ADDITION. The facility is adding room (De Souza House Room #107) on the campus of HOLY SPIRIT CATHOLIC CHURCH. A health and safety inspection was conducted inside and outside. Facility days and hours of operation are Monday through Friday 7:00AM-6PM. Temporarily COVID-19 pandemic hours are Monday through Friday 7:00AM-4:00PM The facility measurements are as follows: INDOORS: 1807.98 SQUARE FEET = 52 CHILDREN OUTDOORS: 5614.04 SQUARE FEET = 75 CHILDREN The center has obtained an approved fire clearance from Fremont Fire Dept on 7/16/2021. Holy Spirit Preschool will have 3 approved PRESCHOOL classrooms (Caterpillar/Butterfly and Dragonfly). Facility will also have one play yard for preschool aged children. Preschool rooms are equipped with varied age appropriate materials and equipment. There are 4 toilets and 5 sinks available for children use. The staff have a separate bathroom which will also serve as an isolation bathroom for ill children. The office will serve as an isolation room for sick children. Individual Medical Services (IMS) policy was discussed. When any changes to IMS are made, 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

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

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 2

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: HOLY SPIRIT PRESCHOOL	FACILITY NUMBER: 010215763
	VISIT DATE: 08/06/2021

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
26
27
28
29
30
31
32

All licensing required documents are posted. Zero Tolerance policies were explained. Notice of Site Visit form was provided and posted. The center was found to be clean, safe, sanitary and in good repair. There were no deficiencies cited during this visit.

A provisional license for 36 preschool aged children operating out of 3 rooms (Caterpillar/Butterfly, and Dragonfly "Room 107") will be issued today, effective 8/6/2021. Fremont Fire Department has granted a temporary fire clearance approval until 1/31/2022. Therefore a provisional license will be approved until 1/31/2022 at which time either a provisional license will be extended OR standard license will be issued.

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: 08/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2