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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070210041
Report Date: 03/26/2025
Date Signed: 03/26/2025 01:25:16 PM

Document Has Been Signed on 03/26/2025 01:25 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:SAN RAMON VALLEY CHRISTIAN ACADEMYFACILITY NUMBER:
070210041
ADMINISTRATOR/
DIRECTOR:		RUSINKO, JENNIFERFACILITY TYPE:
850
ADDRESS:222 WEST EL PINTADO ROADTELEPHONE:
(925) 837-3316
CITY:DANVILLESTATE: CAZIP CODE:
94526
CAPACITY: 102TOTAL ENROLLED CHILDREN: 102CENSUS: 46DATE:
03/26/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Jennifer RusinkoTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On March 26, 2025, Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) M. Domantay met with Director Jennifer Rusinko for the purpose of a change of capacity (decrease) inspection and removing toddler option program of 12 toddlers. Applicant is requesting to decrease the existing preschool program 2 years to entry into first grade from 102 preschool children to capacity 60. Facility is requesting to be licensed to serve a total of 60 preschool children. The program will operate Monday through Friday from 8:30 a.m. to 1:30 p.m. Facility offers snacks for children. Lunch will be provided from home by families for children. LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

The fire clearance was granted and received on 4/12/2024 from the San Ramon Valley Fire for 60 preschoolers, ages 2 years to first grade entry.

INDOOR ACTIVITY SPACE:
There are 3 indoor areas for the preschool program, classroom 115 (green room), classroom 121 (red room), and classroom 123 (purple room). LPA observed a sufficient amount of equipment, furniture, and age appropriate toys. LPA observed a first aid kit backpack in each preschool classroom, hanging on the wall by the entrance area. Medications will be stored in the first aid kit backpack, hanging on the wall of the entrance area.

LPA measured indoor preschool classroom areas. The total classroom space for the preschool classrooms contains a total of 3261.80 square feet, which will accommodate Applicant's request for 60 preschool children. Page 1
Mai LorTELEPHONE: (916) 491-0182
Melissa DomantayTELEPHONE: (510) 725-7021
DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SAN RAMON VALLEY CHRISTIAN ACADEMY
FACILITY NUMBER: 070210041
VISIT DATE: 03/26/2025
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LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. LPA observed a functional carbon monoxide detector in the preschool classroom 121 (red room) located on the wall by the entrance area. LPA observed a manual sign-in/sign-out system.

There are 6 toilets and 6 sinks available for preschool children within the preschool classrooms, and a separate private restroom for the staff is located within the facility. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office and will use the staff restroom, if necessary.



OUTDOOR ACTIVITY SPACE:
LPA toured the outdoor preschool areas. All measurements remain the same from previous inspections, no changes have been made to the outdoor preschool areas per Director. The outdoor preschool play yard areas are fenced with wooden fencing and metal gates that are at least four feet tall. There are no bodies of water on the premises. There is sufficient shading provided by canopies and trees. LPA notified Director that water tables must be fully emptied after every use.

LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Administrator any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Administrator was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.



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SUPERVISOR'S NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR NAME: Melissa DomantayTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: SAN RAMON VALLEY CHRISTIAN ACADEMY
FACILITY NUMBER: 070210041
VISIT DATE: 03/26/2025
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Administrator was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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 Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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 Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.


Exit interview conducted and report was reviewed with the Director, Jennifer Rusinko.
The following items are required before a license will be issued:
1. Regional Manager (RM) final file review.
2. Applicant must complete updated LIC200A form.
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SUPERVISOR'S NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR NAME: Melissa DomantayTELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4