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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010200356
Report Date: 05/10/2023
Date Signed: 05/10/2023 03:46:00 PM

Document Has Been Signed on 05/10/2023 03:46 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:KIDDIE KAMPUS COOPERATIVE PLAY SCHOOLFACILITY NUMBER:
010200356
ADMINISTRATOR:CARNAHAN, MICHELLEFACILITY TYPE:
850
ADDRESS:1711 - 2ND STREETTELEPHONE:
(510) 521-1218
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 24TOTAL ENROLLED CHILDREN: 29CENSUS: 19DATE:
05/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:34 PM
MET WITH:Lori WhittockTIME COMPLETED:
01:45 PM
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On 05/10/2023 at 12:34pm, Licensing Program Analyst (LPA) Catherine Fernandes met with Assistant Director Lori Whittock for a case management inspection. There were 19 preschool age children, two Directors/teachers and five parent volunteers. The center was toured for a health and safety inspection.

There was an incident report that was self reported by the center on 4/28/2023. A child was injured while playing on the swings. LPA Fernandes reviewed statements, observed the child while at the center and reviewed center documentation.

At the time of the incident the child involved was in the mother's care. The center also sent out an email requesting that all parents stop pushing the children and going under the swing (underdog).

Exit interview conducted

Report and Appeal Rights provided.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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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