010200306-1-13-2023-52-CC-SKAR-CN2RGL-20230113120055

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010200306
Report Date: 01/13/2023
Date Signed: 01/13/2023 12:01:00 PM

Document Has Been Signed on 01/13/2023 12:01 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:	HOLY CROSS LUTHERAN NURSERY SCHOOL		FACILITY NUMBER:	010200306
ADMINISTRATOR:	KING, CHRISTIE		FACILITY TYPE:	850
ADDRESS:	1020 MOCHO STREET		TELEPHONE:	(925) 447-1864
CITY:	LIVERMORE	STATE: CA	ZIP CODE:	94550
CAPACITY:	121	CENSUS: 54	DATE:	01/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Chantel Blas		TIME COMPLETED:	12:10 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	On January 13, 2023, Licensing Program Analyst (LPA) Simerjit Kaur conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION and met with director Chantel Blas. The facility was toured to conduct a Health and Safety Inspection. Present the inspection were 8 staff and 54 children. The facility is within ratio and capacity limitations today. The facility operates Monday - Friday from 7:30am - 5:30pm. This building right of main entrance has classrooms 1, 2, 3, 4, with separate boys/girls restroom located in the hallway. The classrooms 5 (Junior K), and room 6 operates in building adjacent to the main entrance. The changing table is within arms reach of the sink. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the inspection. Furniture and equipment are in good condition, and floors are free of tripping hazards during today's inspection. The kitchen/food preparation and storage areas appear to be clean and free of evidence of rodents. All storage containers for solid waste have tight-fitting covers and are in good repair. There are no pools or similar bodies of water at this facility. Outdoor activity space and playground equipment observed to be safe and free of hazards. Play ground equipment is cushioned with tan bark. There is a shaded area provided for the children. LPA observed working carbon monoxide detectors and a fully charged fire extinguisher. Smoke detectors and fire alarms inspections are conducted by Bay Alarm Company. Drinking water is available both indoors and outdoors. The facility serves PM snacks. The menu is also posted. Cleaning supplies/toxins are stored and are inaccessible to children. Per director, there are no firearms present on the premises. Continue on LIC 809-C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit Kaur	TELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: HOLY CROSS LUTHERAN NURSERY SCHOOL	FACILITY NUMBER: 010200306
	VISIT DATE: 01/13/2023

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
26
27
28
29
30
31
32

A copy of the children’s roster and personnel roster was obtained. LPA reviewed children and staff members files. The opener, and the closer staff have current CPR/First Aid certificates. Fire and disaster drills are being conducted every 6 months. Sign in/out logs are maintained through Bright wheel app.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Center Sections 101173 and 101226. 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.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit Kaur	TELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2