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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010215763
Report Date: 03/10/2022
Date Signed: 03/10/2022 03:41:25 PM


Document Has Been Signed on 03/10/2022 03:41 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:HOLY SPIRIT PRESCHOOLFACILITY NUMBER:
010215763
ADMINISTRATOR:TARRANT, CECILIAFACILITY TYPE:
850
ADDRESS:3930 PARISH AVENUETELEPHONE:
(510) 793-2013
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:36CENSUS: 12DATE:
03/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:14 PM
MET WITH:Elizabeth CummingsTIME COMPLETED:
03:45 PM
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On March 10th at approximately 3:20pm LPA Haderer arrived unnanounced for a Case Management visit to review the new shade awning (that was repaired) for the rear playground area of the school. Upon arrival, LPA was met by approved assistant director Elizabeth Cummings. Site Director Cecilia Tarrant was away on vacation this day. There were 2 teachers present and 12 children in care (it was time for children to leave and parents were picking up their children).

LPA observed the structure and noted that it is in safe condition and free from sharp, loose or pointed parts, the new tarp is well attached to the crossbars and will provide ample shade for the children when they are playing in the sandboxes below.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022
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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