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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010205961
Report Date: 02/24/2022
Date Signed: 04/15/2022 08:05:53 AM

Document Has Been Signed on 04/15/2022 08:05 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:FIRST BAPTIST PRESCHOOL - A KIDS KINGDOMFACILITY NUMBER:
010205961
ADMINISTRATOR:NANCY DALTONFACILITY TYPE:
850
ADDRESS:18550 REDWOOD ROADTELEPHONE:
(510) 889-8800
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 29TOTAL ENROLLED CHILDREN: 22CENSUS: 21DATE:
02/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Lisa MillerTIME COMPLETED:
10:45 AM
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On 02/24/2022 at 9:50am, Licensing Program Analyst (LPA) Christina Uribe arrived at the facility for the purpose of issuing an amended Facility Report due to an appeal of finding. Amended report was reviewed with & signed by Facility Representative, Director Lisa Miller. There were 3 teachers & 21 students present at the time of today’s visit. Reports and Notice of Site Visit were given to facility representative.

Additionally, LPA Uribe reviewed one staff member's transcripts and teacher qualifications form.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2022
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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