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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423104
Report Date: 06/23/2021
Date Signed: 06/23/2021 12:07:09 PM

Document Has Been Signed on 06/23/2021 12:07 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:LAKE MERRITT CHILD CARE CENTERFACILITY NUMBER:
013423104
ADMINISTRATOR:LAI SHUI, SHUKYINFACILITY TYPE:
840
ADDRESS:250 12TH STREETTELEPHONE:
(510) 834-3399
CITY:OAKLANDSTATE: CAZIP CODE:
94607
CAPACITY: 10TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/23/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:ElaineTIME COMPLETED:
12:20 PM
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A Prelicensing Visit was conducted today 6/23/21 by Licensing Program Manager (LPM) Mayla Mendoza and Licensing Program Analyst (LPA) Melisssa Domantay. LPM and LPA met today with Center Director Shukyin Lai Shui and Assistant Director Elaine Tam. The applicant has submitted an application for a school-age license. The school-age program will be operating in 1 room located nearest the entryway. Hours of operation will be from 7:30am-6:00pm, Monday through Friday. A health and safety inspection was conducted inside and outside and the measurements are as follows:

INDOORS: 349.51 square feet = 10 children
OUTDOORS: 5431.42 square feet = 72 children

A fire clearance was approved by the Oakland Fire Department for 10 children on 4/13/21. The classroom is equipped with age appropriate materials and equipment. The school-age program will share the play yard with the Preschool Program (preschool program is pending licensure). The yard is fenced in all around. Climbing structures are cushioned by poured rubber in case of fall. There is shade available for the children in the play yard by use of building overhang. There is 1 sink and 1 toilet available for children and provide privacy. There is a designated quarantine room that will be used for sick children as well as the staff bathroom. There are mats available for tired children. The facility serves lunch and snacks and there is a fully equipped kitchen with refrigeration and hot water. Drinking water is available inside and outside classroom by way of children bringing their own water bottles and drinking fountains. The center has first aid supplies available. The sign in/out sheet allows for parents' and staff's full legal signature. Carbon monoxide is fully functional. Fire extinguishers are fully charged. Smoke detectors available. The center director has completed 16 hours of health and safety training including pediatric CPR and First Aid.

This facility plans to provide Incidental Medical Services – IMS. A 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 (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.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Mayla Mendoza
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: LAKE MERRITT CHILD CARE CENTER
FACILITY NUMBER: 013423104
VISIT DATE: 06/23/2021
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Mandated reporter, appeal rights, civil penalties, unusual incident reporting, COVID 19 protocols, Provider Information Notices (PINs), Guardian and fingerprint requirements was discussed today. Licensee 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 are explained. Appeal Rights were also discussed and provided. The center is found to be clean, safe, sanitary, and in good repair.

A license for 10 school aged children will be issued effective 6/23/21. An exit interview was conducted.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Mayla Mendoza
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC809 (FAS) - (06/04)
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