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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073406634
Report Date: 06/08/2022
Date Signed: 06/08/2022 12:15:27 PM


Document Has Been Signed on 06/08/2022 12:15 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:CHILD DAY SCHOOL, LLC - SAN RAMONFACILITY NUMBER:
073406634
ADMINISTRATOR:MILLER, JILLIANFACILITY TYPE:
840
ADDRESS:18868 BOLLINGER CANYON RDTELEPHONE:
(925) 820-2515
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY:20CENSUS: 9DATE:
06/08/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Jillian MillerTIME COMPLETED:
12:25 PM
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On June 8, 2022 at 10:40am, Licensing Program Analyst (LPA) Julia Placencia arrived unannounced to conduct a Case Management - Legal / Non-Compliance Inspection at the school age program of this center. LPA met with director Jillian Miller. Present at time of inspection were two teachers, one volunteer and nine children engaging in daily activities. The purpose of the inspection is the program is currently under increased monitoring as agreed upon during the Noncompliance Meeting between the director and community care licensing management conducted on 3/3/22.

LPA toured the facility and observed all children to be directly supervised during the inspection. The facility is conducting emergency disaster drills as required, last of which was completed on 5/27/22. LPA verified both opening and closing staff have current CPR/First aid training, which expires 4/2024. A physical census was taken of all children present and crossed referenced with the sign in/out sheets. LPA reviewed a random sample of children's and staff files, which were observed to be complete and up to date. LPA observed compliance with AB 633, and signed and dated LIC 9224 documentation in children's files.

No deficiencies have been cited as a result of today's inspection.

Exit interview conducted with director Jillian Miller and copy of report provided. A Notice of Site Visit was provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Julia PlacenciaTELEPHONE: (510) 725-5998
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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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