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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409579
Report Date: 08/22/2023
Date Signed: 08/22/2023 12:40:45 PM

Document Has Been Signed on 08/22/2023 12:40 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:PANTHER HOUSEFACILITY NUMBER:
073409579
ADMINISTRATOR:NICOLE DAMHESELFACILITY TYPE:
840
ADDRESS:3445 HAMLIN RDTELEPHONE:
(925) 297-9750
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 0DATE:
08/22/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Heather Aguilar TIME COMPLETED:
12:40 PM
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On 8/22/23, Licensing Program Analyst (LPA) Melissa Domantay conducted a Prelicensing inspection today, for the new application for a school-age program. LPA met with Applicant Heather Aguilar and toured all areas of the facility designated for the School Age Program for a health and safety inspection. There were no school-age children present during the inspection. The hours of operation are Monday through Friday from 3:00pm to 6:00pm. The facility will operate on the school grounds of St. Perpetua Catholic School.

A fire clearance, with a total capacity of 56 school-age children ages, 4.9 years to 14 years for a total capacity of 56 was received from the Contra Costa County Fire Protection Department, dated 8/15/2023.

LPA observed that the school-age classroom, classroom K-111 has sufficient lighting and appears to be clean and in good condition. LPA observed an ample supply of age appropriate activities, equipment and furniture. The school-age program operates in 1 designated classroom, Classroom K-111. Applicant, Nicole Damhesel provided signed Certification by Principal of St. Perpetua Catholic School for approval to operate in Classroom K-111 and upper grass area on the St. Perpetua Campus Property for after-care. The facility has 1 bathroom for school-age children to utilize. There is a separate staff bathroom on school grounds for staff to utilize. The building has a fully charged 2A10BC fire extinguisher, working fire alarm and first aid supplies. There is a working telephone at the center. LPA did not observe any hazardous items that would be accessible to children. Facility will provide water for children, with water still accessible to children inside and outside. Facility will provide PM snacks. Facility will utilize electronic sign in/out.

Per Applicant, Heather Aguilar, will purchase carbon monoxide detector and will send proof of carbon monoxide detector and provide proof it is operational inside Classroom K-111 to LPA.


See 809-C for continuance.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2023
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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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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: PANTHER HOUSE
FACILITY NUMBER: 073409579
VISIT DATE: 08/22/2023
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LPA observed the outdoor upper play yard grass area. LPA observed ample amount of shade for children. Per LPM Mendoza, school age program is exempt from outdoor fencing due to operation on school grounds. The facility will not provide transportation for children.

The isolation area will be inside Classroom K-111 in the corner by the food prep/refrigerator area.

Nicole is considered a qualified Director with current CPR/First Aid and mandated reporter training's completed.

If this facility plans to provide Incidental Medical Services – IMS. A 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 the ADA, available at: http://www.ada.gov/childqanda.htm.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. LPAs reviewed responses and provided technical assistance including postings. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

A School-Age license for a capacity of 56 children will be granted today, 8/22/23. There are no deficiencies being cited today. Exit interview conducted with Applicant Heather Aguilar.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC809 (FAS) - (06/04)
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