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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010214464
Report Date: 05/28/2026
Date Signed: 05/28/2026 11:52:01 AM

Document Has Been Signed on 05/28/2026 11:52 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:FUSD - CABRILLO STATE PRESCHOOLFACILITY NUMBER:
010214464
ADMINISTRATOR/
DIRECTOR:		BRENDA BETHANCOURTFACILITY TYPE:
850
ADDRESS:36700 SAN PEDRO DRIVETELEPHONE:
(510) 792-3015
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 21DATE:
05/28/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Pooja SinghTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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On May 28, 2026, at 8:35am, Licensing Program Analyst (LPA) Randy Miranda arrived unannounced for an annual inspection for compliance to Health and Safety and met with the Site Director, Pooja Singh. Present for today's inspection was the morning site director, afternoon site director, two paraeducators, one volunteer, and 21 preschool-age children. Facility closure for summer break will be in effect from June 2, 2026 through August 12, 2026. Licensure: Ages 3 to 5 years. Hours of operation are 8:00AM to 4:00PM, Monday through Friday. Subject to conditions of waiver to be posted. Licensed in portable on school grounds. Total capacity is 24.

The facility is clean and well organized, with age-appropriate furnishings and equipment in good repair. Surfaces, including floors and countertops, are free of hazards and toxins. There is a working carbon monoxide detector (tested and functioning), and smoke detectors are installed in the classroom ceilings. A Class 3A40BC fire extinguisher is located next to the main entrance door. The fire extinguisher was last inspected by Arrow Fire Protection on June 11, 2025. The fire alarm system and smoke detectors were last inspected by the Fremont Fire Department on April 17, 2026.

The classroom contains ample age-appropriate toys that appear safe and in good condition. There are no bodies of water accessible to children in care. Cubbies are available for all children's personal belongings. The outside play area is shared with the kindergarten school. Two waivers are posted: (1) to ensure a schedule is maintained that limits the number of children in the play area at the same time, and (2) to allow children to use the elementary school bathrooms, provided they are accompanied by facility staff and no elementary school children are present. LPA observed the playground structure and blacktop area to be in safe operating condition and free from sharp, loose, or pointed parts. The areas around or under high climbing equipment have appropriate cushioned material to absorb falls. Shade and drinking fountains are available in the play area. Teachers supervise children at all times while outdoors.

NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Randy Miranda
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2026
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 9
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: FUSD - CABRILLO STATE PRESCHOOL
FACILITY NUMBER: 010214464
VISIT DATE: 05/28/2026
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All required posted documents were present. Disaster/fire drills are conducted monthly by the main school; the most recent drill was completed on December 12, 2025. The classroom has two separate bathrooms with one toilet and one sink in each. Staff bathrooms are separate from children’s bathrooms and are located next to the playground. All toilets, handwashing facilities, and cleaning areas are in safe and sanitary operating condition. Trash bins have tight-fitting lids, and all surfaces accessible to children are clean and free of toxins. The sign-in/out process is electronic. The process was reviewed, and all children were properly signed in and accounted for. The snack menu is posted and visible for review, and all food/snacks were within expiration dates.

Children’s files reviewed were current and in compliance with Title 22 and Title V regulations. Staff files confirm required background clearances. At least one opening/closing staff member holds current Pediatric CPR/First Aid certification. The director was reminded to renew CPR/First Aid and Mandated Reporter certificates every two years.

Site 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 childcare 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). Children bring their own water bottles, and the school also provides bottled water to children. Lead testing is complete and documented.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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) 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-care-centers/.

NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Randy Miranda
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC809 (FAS) - (06/04)
Page: 8 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: FUSD - CABRILLO STATE PRESCHOOL
FACILITY NUMBER: 010214464
VISIT DATE: 05/28/2026
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Effective August 1, 2003, California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within 7 business days.

Site Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

No deficiencies were issued during today’s inspection. This report will remain on file for 3 years.


A notice of site visit was given and must remain posted for 30 days. Appeals Rights provided.

Exit interview conducted and report was reviewed with Site Director, Pooja Singh.
NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Randy Miranda
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2026
LIC809 (FAS) - (06/04)
Page: 9 of 9