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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 070209920
Report Date: 07/17/2025
Date Signed: 07/17/2025 04:14:54 PM

Document Has Been Signed on 07/17/2025 04:14 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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:SRVSACCA - KIDS COUNTRY-BOLLINGER CANYONFACILITY NUMBER:
070209920
ADMINISTRATOR/
DIRECTOR:		NG, CELINAFACILITY TYPE:
840
ADDRESS:2300 TALAVERA DRIVETELEPHONE:
(925) 552-4481
CITY:SAN RAMONSTATE: CAZIP CODE:
94583
CAPACITY: 126TOTAL ENROLLED CHILDREN: 126CENSUS: 32DATE:
07/17/2025
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:19 AM
MET WITH:Rowena AlegreTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Caroline Colson met with Rowena Alegre, Center Director for Kids' Country for Live Oak, for an increase in capacity inspection. There are 32 children and 7 staff members. The facility is requesting 189 school-age children from transitional kindergarten and above. The program will operate Monday through Friday from 7:00 AM to 6:30 PM. The fire clearance was granted and received on 5/22/2025. LPA reviewed a letter from the School District's Assistant Superintendent on file allowing the program to utilize the childcare building and the multipurpose room (MPR) for the capacity requested.

Physical Plant: The facility has classrooms or portables 1 and 2, classroom 603 and the multipurpose room and an outdoor play area. There is adequate heating, lighting, and ventilation. There are no cleaning solutions, chemicals, or other hazards accessible to children. Per Applicant, there are no weapons at the facility.

Classrooms: Furniture and equipment are age appropriate and in good repair. There are separate storage areas for children’s belongings. LPA observed a sufficient amount of equipment, tables, chairs, and cubbies/hooks. Drinking water is provided by a water fountain/sink in each classroom. There are three (3) first aid kits and medication properly stored. LPA observed a functional carbon monoxide detector and smoke detector. Parents use a sheet to sign in and sign out. The facility will be providing morning snack and afternoon snack. During summer months, breakfast and an afternoon snack are provided. Parents provide their children lunches only during the summer.


Please See LIC 809 C for Additional Information

NAME OF LICENSING PROGRAM MANAGER: Michael Duarte
NAME OF LICENSING PROGRAM ANALYST: Caroline Colson
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2025
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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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: SRVSACCA - KIDS COUNTRY-BOLLINGER CANYON
FACILITY NUMBER: 070209920
VISIT DATE: 07/17/2025
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The facility has requested a capacity of 189 school-age children. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement. Therefore, LPA did not take measurements. The children have access to all children's school restrooms located on campus, and a separate private restroom for the staff located in the hallway. The isolation area will be the director's office. The staff bathroom will be the isolation bathroom.

OUTDOOR ACTIVITY SPACE:

There is one outdoor area on the property. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall. LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by overhangs, trees, canopies, and shade structures. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement. Therefore, LPA did not take measurements.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and ADA, available at http://www.ada.gov/childqanda.htm


Please See LIC 809 C for Additional Information

NAME OF LICENSING PROGRAM MANAGER: Michael Duarte
NAME OF LICENSING PROGRAM ANALYST: Caroline Colson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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 CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: SRVSACCA - KIDS COUNTRY-BOLLINGER CANYON
FACILITY NUMBER: 070209920
VISIT DATE: 07/17/2025
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LPA reviewed with Applicant the LIC 311 A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA discussed 100% supervision is always required in all areas that children have access to including the bathroom. Personal Rights, inspection authority, reporting requirements, maintaining buildings and grounds was reviewed. Staff Qualifications, Staff to Children’s ratios and Capacity was explained to ensure compliance. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Applicant 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.

To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Please See LIC 809 C for Additional Information
NAME OF LICENSING PROGRAM MANAGER: Michael Duarte
NAME OF LICENSING PROGRAM ANALYST: Caroline Colson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: SRVSACCA - KIDS COUNTRY-BOLLINGER CANYON
FACILITY NUMBER: 070209920
VISIT DATE: 07/17/2025
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The following items will need to be corrected prior to receiving a Single License:
1. Applicant will need to update menu with portion sizes.
2. Sign In and Sign Out sheets needs to be updated to allow parents to sign their full legal signature.
3. Trash Bins with lids for all waste products.
4. Uncontaminated water pitchers need to be purchase to allow children to refill their water bottles for indoor and outdoor activities.
5. Applicant needs to purchase 1% milk.
6. Carbon Monoxide is needed for the MPR area.
7. Applicant needs to purchase additional food and ensure food is properly labeled and safe for children.
8. Applicant needs to purchase missing items for all three first aid kits.
9. Applicant needs to ensure all children and staff records are complete.
10. Applicant will need to update the LIC 500 to reflect the correct position for each staff member based on qualifications.
11. Applicant needs to ensure that the director has a complete 16 Hours of Preventative Health certificate.
12. Licensing Board needs to be updated.
13. Discussion with Assistant Superintendent regarding new letter for classrooms' maximum capacities.
14. A final review will need to be conducted on all submitted documents.
NAME OF LICENSING PROGRAM MANAGER: Michael Duarte
NAME OF LICENSING PROGRAM ANALYST: Caroline Colson
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC809 (FAS) - (06/04)
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