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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700552
Report Date: 12/13/2021
Date Signed: 12/13/2021 11:36:30 AM

Document Has Been Signed on 12/13/2021 11:36 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MOD KIDS, CO.FACILITY NUMBER:
015700552
ADMINISTRATOR:DHILLON, RENNUFACILITY TYPE:
850
ADDRESS:4938 PASEO PADRE PARKWAYTELEPHONE:
(510) 745-7311
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 0DATE:
12/13/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Shana NijjarTIME COMPLETED:
11:45 AM
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A Prelicensing Visit was conducted today by Licensing Program Analyst (LPA), Melanie Otsuji. LPA met with Applicant, Shana Nijjar. The applicant has submitted an application for a PRESCHOOL. A health and safety inspection was conducted inside. This facility does not have an outside play yard therefore this facility will operate as a PART-TIME PRESCHOOL with a maximum of 3hrs/ per day and up to 15hrs/per week. The preschool program will operate in 1 classroom. Operating hours Monday through Friday from 8:00AM - 6:00PM. The measurements are as follows:

INDOORS: 1592.45 square feet = 27 children
OUTDOORS: NO OUTDOOR SPACE

Measurements were taken of each room. There is one separate staff bathroom located inside the strip mall complex. One of the children's restrooms will serve as an isolation restroom if a child becomes ill. The restroom is to be thoroughly sanitized after an ill child utilizes it. There is a fully stocked first aid kit with all required equipment available and a locked cabinet for stored medications. Children will bring lunch and AM or PM snacks from home. Facility will have back up snacks should a child forget. No exit doors were blocked. There is ample toys and furnishings throughout the center for children's use. Children will not be napping here as this facility will operate as a part time center, however, should a child need to rest, cots will be made available.

There are 2 toilets (sized appropriately) and 3 sinks available for children's use. Heating and lighting was adequate. The front room is not to be used for any classroom instruction. Front room can only be used for administrative activities.

Report continued on 809C
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MOD KIDS, CO.
FACILITY NUMBER: 015700552
VISIT DATE: 12/13/2021
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The center Director will be Shana Nijjar and a directors packet with all required documentation was submitted to CCL to complete the application. There is an approved provisional fire clearance signed on 11/4/2021 for 30 preschool aged children.

There are no bodies of water nor hazards found on the premises. All toilets and hand washing facilities are in safe and sanitary operating conditions. All licensing required documents are posted. This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 the ADA, available at: http://www.ada.gov/childqanda.htm

A provisional license for 27 preschoolers operating out of 1 classroom recommended effective today, 12/13/2021. Provisional license will be effective through 2/4/2022 and has the option to be made a standard license once full fire clearance is received. See License for provisions and conditions.

An exit interview was conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
LIC809 (FAS) - (06/04)
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