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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070212743
Report Date: 01/12/2024
Date Signed: 01/12/2024 10:26:46 AM


Document Has Been Signed on 01/12/2024 10:26 AM - 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:WCCUSD - DOVERFACILITY NUMBER:
070212743
ADMINISTRATOR:ATTIG, ZEENAFACILITY TYPE:
850
ADDRESS:1871 21ST STREETTELEPHONE:
(510) 231-1420
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY:24CENSUS: 22DATE:
01/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Demi BranchTIME COMPLETED:
10:30 AM
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On 1/12/2024 at 9:20 AM, Licensing Program Analyst (LPA) Christina Watts conducted a Plan of Correction (POC) inspection at WCCUSD at Dover. LPA met with Early Learning Program Officer, Demi Branch, and explained the purpose of this visit. During today's inspection, there were 22 preschool aged children in care with 3 staff (1 FQ Teacher and 2 Aides) The Early Learning Program Officer stated there are 38 preschool children enrolled. All staff caring and supervising children have Criminal Record Clearance per WCCUSD.

LPA is following up on a citation given to the facility on 12/08/2023 for failure to conduct lead testing for facility. Facility has submitted multiple documents to LPA however LPA could not accept the documents as the documents does not meet the requirements for exemption of Lead Testing. LPA reviewed and discussed with the Early Learning Program Officer the PIN 21-21.1 CCP and part of the ROM 23-03-CCP regarding Child Care Center built after January 1, 2010. LPA provided a copy of the PIN 21-21.1 CCP to the Early Learning Program Officer. LPA extended the Plan of Correction until 02/12/2024 for facility to come into compliance. Early Learning Program Officer stated she will speak with her management find a solution to come back into compliance.

During today's inspection, there were no violation observation.

Exit interview conducted and report was reviewed with Early Learning Program Officer, Demi Branch. A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 421-3587
LICENSING EVALUATOR NAME: Christina WattsTELEPHONE: (510) 246-1797
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2024
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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