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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010200334
Report Date: 12/14/2023
Date Signed: 12/14/2023 01:04:14 PM

Document Has Been Signed on 12/14/2023 01:04 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:JOHN KNOX CO-OP PRESCHOOLFACILITY NUMBER:
010200334
ADMINISTRATOR:JAMES, LESLIEFACILITY TYPE:
850
ADDRESS:7421 AMARILLO ROADTELEPHONE:
(925) 828-2887
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 30TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
12/14/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Leslie JamesTIME COMPLETED:
01:00 PM
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On 12/14/23, Centralized Application Bureau (CAB) Licensing Program Analyst Andrew Elliot met with Facility Representative Leslie James for the purpose of a licensee requested case management visit to assess a capacity increase. Applicant requests to add an additional classroom for use in the preschool program and requested a capacity increase to 44 preschool age children from a capacity of 30 preschool age children currently approved for their current preschool license. The program currently operates Monday through Friday from 8:30 a.m. to 1:00 p.m. The fire clearance was granted on 11/02/2023. The facility will provide morning snacks.

INDOOR ACTIVITY SPACE:
There are three preschool classrooms (Classroom A, Classroom B, and Classroom C). LPA observed the classrooms to be equipped with sufficient amount of equipment, age-appropriate toys, tables, chairs, cubbies, and napping cots. There is a first aid kit in each of the classrooms. Medications will be stored in the office in a locked box. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. The applicant stated there are no poisons or firearms on the premises. LPA observed a functional carbon monoxide detector in the each classroom. LPA observed an electronic sign-in/sign-out system.

LPA measured three classrooms. The total classroom space contains a total of 2209.12 square feet, which will accommodate Applicant's request for 44 preschool children. There are 3 toilets and 5 sinks for the children, and a separate private restroom for the staff located off of the facility in the church which shares a campus with the facility. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor activity spaces on the property. The outdoor play area is fenced with a chain link fence that is at least four feet tall and separates the preschool yard from the parking lot and areas of the campus which are not associated with the facility. LPA observed a sufficient amount of equipment and toys. The play structure includes a safety label, which designates use for children 5 to 12 years old. The applicant provided the LPA with additional documentation showing that the play structure is also designated for use by children between 2 and 5 years old. There are no bodies of water on the premises. There are shaded areas supplied by trees and overhangs.
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Andrew Elliott
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2023
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: JOHN KNOX CO-OP PRESCHOOL
FACILITY NUMBER: 010200334
VISIT DATE: 12/14/2023
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LPA measured the outdoor activity space. The outdoor play area contains a total of 5885.19 square feet, which will accommodate Applicant's request for 44 preschool children. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

APPLICANT KNOWS FACILITY PLANS TO PROVIDE IMS: This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. 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) or (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

LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. 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 reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Applicant was informed of the MyChildCarePlan.org site, 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 platform. 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.

Exit interview conducted and report was reviewed with the applicant, (include name).

The following items are required before a license will be issued:

1. Licensing Program Manager (LPM) final file review.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Andrew Elliott
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023
LIC809 (FAS) - (06/04)
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