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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413456
Report Date: 09/29/2021
Date Signed: 09/29/2021 10:08:03 AM

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:UNIVERSITY OAKS PRESCHOOLFACILITY NUMBER:
434413456
ADMINISTRATOR:ELLEN WILLIAMSFACILITY TYPE:
850
ADDRESS:858 UNIVERSITY AVENUETELEPHONE:
(650) 641-0194
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY:32CENSUS: 15DATE:
09/29/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Deborah SwailTIME COMPLETED:
10:27 AM
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On 09/292021 at 08:50am, LPA Jonathan Williams arrived at the facility unannounced for the purposes of conducted a Plan of Correction visit in response to deficiency cited during site visit conducted on 09/16/2021. LPA was met by Director, Deborah Swail. Present for today's inspection are the Director, three fingerprint cleared and associated teachers, and 15 preschool-aged children in care.

During site visit conducted on 09/16/2021, LPA observed that a screw fastening a climbing pole to a wood board on a high climbing structure in the outdoor play area was loose. Type B deficiency was assessed and play structure placed off-limits until deficient conditions were fixed. During today's visit, LPA toured the outdoor play area and inspected the high climbing structure. LPA observed during today's visit that the climbing pole was fitted with a new screw and LPA observed that it was tight enough to support the weight of a child at the time of this inspection.

See cleared POC letters dated today, 09/29/2021. POC letters were provided to Director during today's visit. No deficiencies were cited during today's visit. Notice of Site Visit was provided and must be posted for a period of 30 days. Appeal Rights provided to the Director. Exit interview conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Jonathan WilliamsTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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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