<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700744
Report Date: 02/22/2024
Date Signed: 02/22/2024 01:37:05 PM

Document Has Been Signed on 02/22/2024 01:37 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:PRIMARY SCHOOL-BAY AREA, THEFACILITY NUMBER:
015700744
ADMINISTRATOR:MARY GASTONFACILITY TYPE:
850
ADDRESS:750 FARGO AVENUETELEPHONE:
(510) 736-2457
CITY:SAN LEANDROSTATE: CAZIP CODE:
94579
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 0DATE:
02/22/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mia Lopez and Mary GastonTIME COMPLETED:
01:30 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 02/22/2024 at 1 pm, Licensing Program Analyst (LPA) Manel Estoesta and Licensing Program Manager (LPM) Jason Jang conducted an Informal Meeting with the Licensee. LPA and LPM met with the Operations Director Mia Lopez and Program Director Mary Gaston.


In this meeting the following was discussed.

1. Lack of Supervision Incident on 12/12/2023

2. Facility Visit on 01/09/2024 that includes Type A Deficiency Cited Lack of Supervision Violation, Plan of Correction taken and Immediate Civil Penalty.

3. Local Resource and Referral Notification.

4. Facility Compliance Plan that includes recommended course of action.

Exit interview conducted and report was reviewed.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
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 1