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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212589
Report Date: 06/14/2023
Date Signed: 06/14/2023 01:40:18 PM


Document Has Been Signed on 06/14/2023 01:40 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:FREMONT CHRISTIAN PRESCHOOLFACILITY NUMBER:
010212589
ADMINISTRATOR:JIMENEZ, NATHANIELFACILITY TYPE:
850
ADDRESS:4760 THORNTON AVENUETELEPHONE:
(510) 744-2260
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY:197CENSUS: 107DATE:
06/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nathaniel JimenezTIME COMPLETED:
01:45 PM
NARRATIVE
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On June 14, 2023 at approximately 11:30am Licensing Program Analyst (LPA) Haderer arrived unannounced to investigate a recent incident that occurred on May 12, 2023. Present there were 107 children in care and 17 teachers, the center is in ratio.
Synopsis of incident:
On Friday, May 12th at approximately 5:00pm during line up time, the teacher (T1) for preschool classroom number P8 discovered that a child (C1) was missing and called out to her. A parent informed the teacher she saw the child by the preschool exit gate. T2 and another teacher T3 went to the gate and did not see C1 there. They continued out the gate and went to the main school atrium area (approximately 100 feet away) and saw C1 in the atrium area looking back an them through the glass.

C1 had left the preschool gate and entered the atrium of the main school but never left the main school campus. T2 and T3 retrieved C1 and brought her back into the preschool.

Site directed explained there was a science fair (steam fair) scheduled at 6:00pm that evening so all parents were at the school at 5:00pm for an early pick up. Director believes that C1 might have been in a group of families and children leaving and a parent may have thought C1 belonged to one of the families and let her out of the gate and similarly a parent let her into the atrium area. Director estimated C1 was only away from the preschool area for a few minutes. C1's father(P1) arrived a few minutes after 5:00pm and was informed of the incident. This is a Type A deficiency, see LIC809D for details and plan of correction.

Licensee will be required to publicly post the Type A deficiencies for 30 days and provide a copy of the Type A deficiency to all currently enrolled children's parents and collect their signatures and dates on the LIC9224 Acknowledgement of Receipt of Licensing Reports form. For the next 12 months, licensee will be required to provide a copy of the Type A deficiency to parents of newly enrolled children and collect their signatures and dates on the LIC9224 Acknowledgement of Receipt of Licensing Reports forms and keep them in the children's files.


A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with site director Nathaniel Jimenez.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2023
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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Document Has Been Signed on 06/14/2023 01:40 PM - It Cannot Be Edited

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: FREMONT CHRISTIAN PRESCHOOL
FACILITY NUMBER: 010212589

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/26/2023
Section Cited
CCR
101229(a)(1)

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01229 Responsibility for Providing Care and Supervision
(a)(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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The preschool will require that a second staff person be stationed by the exit gates at pick up time to ensure no unattended children may leave the campus. T1 and T2 of P8 will be required to review CCLD online videos regarding Supervising of Children and Children's Rights. After viewing the videos,
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Based on reporting and interviews, the licensee did not meet the requirement of Responsibilty for Providing Care and Supervision as evidenced by a child that left the preschool campus which poses an immediate Health and Safety risk to children in care.
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staff will complete questionnaires and submit the original ink-signed and dated copies to the LPA.
Quarterly reminders to parents will be sent to reinforce the safety measures required and not to let children other than their own leave through any gates.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Russell HadererTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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