010200306-2-2-2024-52-CC-SKAR-D23QVX-20240202113103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010200306
Report Date: 02/02/2024
Date Signed: 02/02/2024 11:31:08 AM

Document Has Been Signed on 02/02/2024 11:31 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 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: 48	DATE:	02/02/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Angela Dempsey		TIME COMPLETED:	11:35 AM

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 February 2, 2023, Licensing Program Analyst (LPA) Simerjit Kaur conducted an UNANNOUNCED ANNUAL REQUIRED 3 YEAR INSPECTION and met with Assistant Director Angela Dempsey. The facility was toured to conduct a Health and Safety Inspection. Present the inspection were 7 staff and 48 children. The facility is within ratio and capacity limitations today. The facility operates Monday - Friday from 7:30am - 5:30pm. There are two buildings designated for preschool. The building on right of the main entrance has classrooms 1, 2, 3, 4, with separate boys/girls restroom located in the hallway. The classrooms 5 A, B, 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 today. 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, smoke defectors 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. A fire/disaster drill was last conducted on 1/31/24. 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: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HOLY CROSS LUTHERAN NURSERY SCHOOL	FACILITY NUMBER: 010200306
	VISIT DATE: 02/02/2024

NARRATIVE

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A copy of the children’s roster was obtained. LPA reviewed children and staff members files. The opener, and the closer staff have current CPR/First Aid certificates. Sign in/out logs are maintained.

Facility director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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 PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.
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: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: HOLY CROSS LUTHERAN NURSERY SCHOOL	FACILITY NUMBER: 010200306
	VISIT DATE: 02/02/2024

NARRATIVE

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Licensee was reminded that California law requires Licensees to report unusual incidents and/or injuries to children in care, to the child's parents, and to the Department within 24 hours by phone. Within seven (7) days from the incident, Licensee’s must submit the Unusual Incident/Injury form (LIC 624B) to the Department. Licensee was reminded that any structural changes or additions to the home must be reported to Community Care Licensing.

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 with Assistant Director Angela Dempsey.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Simerjit Kaur	TELEPHONE: (510) 622-2632
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC809 (FAS) - (06/04)

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