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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073404763
Report Date: 10/12/2022
Date Signed: 10/12/2022 12:54:13 PM


Document Has Been Signed on 10/12/2022 12:54 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:PUSD - PARKSIDE PRESCHOOLFACILITY NUMBER:
073404763
ADMINISTRATOR:LILIAN BLADEFACILITY TYPE:
850
ADDRESS:985 WEST 17TH STREETTELEPHONE:
(925) 473-2420
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY:24CENSUS: 16DATE:
10/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lilian BladeTIME COMPLETED:
12:55 PM
NARRATIVE
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On 10/12/22 at 10:00 AM Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced Annual Inspection at Parkside Preschool. During today's inspection it was determined that Parkside Preschool has relocated into a new building Parkiside Elementary school campus. Facility previously was located in a Portable on elementary school campus. LPA observed a new playground that is shared with the Kindergarten classroom.

The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the lead teacher Lilian Blade.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022
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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Document Has Been Signed on 10/12/2022 12:54 PM - It Cannot Be Edited

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: PUSD - PARKSIDE PRESCHOOL
FACILITY NUMBER: 073404763

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/26/2022
Section Cited

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101237 Alterations to Existing Buildings or New Facilities (a) Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s). This requirement is not met as evidenced by:
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Based on observation, record review and interview, the licensee did not comply with the section cited above by not informing CCLD of the new building and location of the preschool, which poses a potential health, safety or personal rights risk to persons in care.
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Additional information may be requested by the app unit.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Michelle SuttonTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022
LIC809 (FAS) - (06/04)
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