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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408875
Report Date: 05/24/2023
Date Signed: 05/24/2023 12:14:47 PM

Document Has Been Signed on 05/24/2023 12:14 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CALVARY CHRISTIAN PRESCHOOLFACILITY NUMBER:
073408875
ADMINISTRATOR:MULLENS, AMYFACILITY TYPE:
830
ADDRESS:3425 CONCORD BLVDTELEPHONE:
(925) 682-6728
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
05/24/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Amy MullensTIME COMPLETED:
12:15 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 05/24/2023 at 11:15 AM, Licensing Program Analyst (LPA) Christina Watts conducted a Plan of Correction (POC) insepction at Calvary Christian School - Infant Program. LPA met with Director, Amy Mullens and explained the purpose of today inspection. During today's inspection, there were 6 infants in care with 2 staff. Director stated there are 6 children enrolled.

On 05/08/2023, Facility was cited Type B for Infant Needs and Services forms. During inital visit, LPA observed 5 infants Needs and Services forms were not updated and completed. On 05/19/2023, Facility submitted Plan of Correction when facility submitted Needs and Services plan to licensing. During today's inspection, LPA inspected facility files and observed completed Needs and Services plans for all 5 infants.

As of 05/24/2023, Deficiency has been CLEARED. Clearance letter has been printed and provided to Director during inspection.

No deficiencies were cited during today's inspection.

Exit interview was conducted and report was reviewed with the Director, Amy Mullens. A Notice of Site Visit was given and must remain posted for 30 consecutive days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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