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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013414632
Report Date: 08/23/2022
Date Signed: 08/23/2022 03:55:12 PM


Document Has Been Signed on 08/23/2022 03:55 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:PRINCIPLED ACADEMY, THEFACILITY NUMBER:
013414632
ADMINISTRATOR:FLORENDO, AURELIAFACILITY TYPE:
850
ADDRESS:2305 WASHINGTON AVENUETELEPHONE:
(510) 351-6400
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:34CENSUS: 16DATE:
08/23/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Isaac DurstTIME COMPLETED:
04:10 PM
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A Case Management Visit was conducted on this date 08/23/2022 by Licensing Program Analyst (LPA), Melanie Otsuji. LPA met with Applicant, Isaac Durst and Director, Aurelia Florendo. The center has submitted an application for an increase in capacity from 34 to 51 children. Hours of operation are from 7:00am-6:15pm, Monday through Friday. Present during today's visit were 5 additional staff members and 16 preschool aged children. A health and safety inspection was conducted inside and outside. Measurements are as follows:

INDOORS: 1659.70 square feet = 47 children
OUTDOORS: 28898.48 square feet = 385 children

The center has obtained an approved fire clearance from Alameda County Fire Department on 8/3/2022 for the capacity increase. Playground equipment is in good condition. Drinking water is available inside and outside. All toilets and hand washing facilities are in safe and sanitary operating conditions. Preschool rooms are equipped with varied age appropriate materials and equipment. There are 9 toilets and 9 sinks available for children use. The staff have a separate bathroom in the main building which will also serve as an isolation bathroom. The sanctuary will serve as an isolation room for sick children. Incidental 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. 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 license for 47 preschool aged children operating out of 3 rooms (Blue Room, Green Room and Gold Room) will be issued today, effective 8/23/2022. An exit interview was conducted with Applicant, Isaac Durst.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
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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