073407412-3-8-2021-02-CC-MMEA-BYX5WC-20210308191853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407412
Report Date: 03/04/2021
Date Signed: 03/08/2021 07:21:05 PM

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:	ST. AGNES PRESCHOOL		FACILITY NUMBER:	073407412
ADMINISTRATOR:	SCIACQUA, LORI		FACILITY TYPE:	850
ADDRESS:	3886 CHESTNUT AVE		TELEPHONE:	(925) 689-3990
CITY:	CONCORD	STATE: CA	ZIP CODE:	94521
CAPACITY:	20	CENSUS:	DATE:	03/04/2021
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:			TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	A Case Management tele-visit was conducted on this date 3/4/21 by Licensing Program Manager (LPM), Mayla Mendoza. LPM met with center director, Lori Sciacqua. The center has submitted an application for a ROOM CHANGE. Center is located on the premises of the St. Agnes Church's Private School in the Cauchi Hall Building. The 1 classroom in the Cauchi Hall Building will now be used, as the previous room will no longer be available. Hours of operation are from 8:00am-11:30am, Monday through Friday. A health and safety tele-inspection was conducted inside and outside. The following is the total overall measurement: INDOORS: 828.311 square feet = 24 children OUTDOORS: 50400 square feet = 672 children Playground equipment is in good condition. Drinking water is available inside and outside. A yard waiver is currently in place for the shared yard between the private school and the preschool program. Center also has a waiver in place to share the bathroom toilet and sinks with the Private School. All toilets and handwashing facilities are in safe and sanitary operating conditions. Facility has a functioning carbon monoxide detector. This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021

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: ST. AGNES PRESCHOOL	FACILITY NUMBER: 073407412
	VISIT DATE: 03/04/2021

NARRATIVE

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A review of staff records on 3/4/21 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The center has obtained an approved fire safety inspection from the Contra Costa County Fire Department. All licensing required documents are posted.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. LPM discussed COVID-19 protocols and provided technical assistance including postings. 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 were explained. Notice of Site Visit form was provided and posted.
The center was found to be clean, safe, sanitary and in good repair. There are no deficiencies cited during this visit. A license for 20 preschool children in the new classroom will be issued effective today 3/4/21

An exit interview was conducted.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 873-6408
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2021

LIC809 (FAS) - (06/04)

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