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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700706
Report Date: 10/05/2023
Date Signed: 10/05/2023 12:54:58 PM

Document Has Been Signed on 10/05/2023 12:54 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 EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CUSD MONTCLAIRE CUPERDOODLE PRESCHOOLFACILITY NUMBER:
435700706
ADMINISTRATOR:ALICE CHANFACILITY TYPE:
850
ADDRESS:1160 ST. JOSEPH AVENUETELEPHONE:
(408) 252-3000
CITY:LOS ALTOSSTATE: CAZIP CODE:
94024
CAPACITY: 48TOTAL ENROLLED CHILDREN: 40CENSUS: 39DATE:
10/05/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lilly VazquezTIME COMPLETED:
01:15 PM
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On 10/05/2023 at 10:00am, Licensing Program Analyst (LPA) Christina Uribe conducted an Unannounced Case Management Visit. LPA met with facility representative, Lilly Vazquez, also present at the time of the inspection were 6 staff & 39 children. The facility is within ratio & capacity compliance today. The purpose of today's visit is to evaluate plan of corrections for deficiencies cited during an annual inspection on 09/01/2023.

During today's visit, LPA Uribe reviewed children's and personnel records, interviewed staff, and made observations within the classroom. The facility is stocked with one first day kit in each classroom and all staff are aware of where they are located. All staff members present have a personnel record and filed. All personnel records have the correct, complete, and updated Mandated Reporter Certificates for Child Care Providers. LPA Uribe reviewed 4 staff transcripts and completed 3 Evaluation of Teacher Qualifications (LIC 9095) forms. Children's records which were reviewed all have the required forms filed, two children's files need to be revised for correction but they are not a deficiency by nature.

All plan of corrections assigned on 09/01/2023 have been cleared today by LPA Uribe. Letter of Deficiencies Cited Cleared were given to the facility representative.

No deficiencies cited during today's inspection. One advisory note issued for children's records needing to have some forms corrected.

Notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative, Lilly Vazquez.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
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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