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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010210783
Report Date: 01/30/2023
Date Signed: 01/30/2023 11:39:09 AM

Document Has Been Signed on 01/30/2023 11:39 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:RESURRECTION LUTHERAN PRESCHOOLFACILITY NUMBER:
010210783
ADMINISTRATOR:WAZHMA MASARWEHFACILITY TYPE:
850
ADDRESS:7557A AMADOR VALLEY BOULEVARDTELEPHONE:
(925) 829-5487
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 44DATE:
01/30/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Wazhma MasarwehTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced on today's date, 1/30/2023, to conduct a Case Management - Licensee Initiated inspection. LPA met with Director Wazhma Masarweh. Also present were 10 additional staff members and 44 preschool aged children.

Facility has suffered water damage from the recent winter storms that impacted California. The water damage has forced facility to temporarily close the following children spaces: Classroom 4, Classroom 5, 2 toilets and 1 sink within classroom 4, Hallway Bathroom (1 toilet, 1 urinal and 1 sink), Side Playground and Art yard. The following licensed spaces still remain for children use: Classroom 1, Classroom 6, Playground behind Classroom 6, and the Courtyard.

Facility has requested to utilize Executive Order (EO) N-1-23 "Governor's Proclamation of a State of Emergency to Address Severe Winter Storms." Facility is requesting to temporarily utilize the church Narthex space while the affected spaces are being repaired. Repairs are expected to take through March 2023. Director states that the Narthex space is being used on a rotational basis with the PreK classroom and 4's classroom. LPA conducted a health and safety inspection of the facility. Measurements of the temporary space was taken and no more than 21 preschool aged children shall utilize the Narthex space at any given time. Facility will also utilize the Narthex bathrooms. In the Narthex bathrooms, there are a total of 3 toilets, 1 urinal and 3 sinks available for children use. Staff will continue to utilize the courtyard bathroom.

LPA received a temporary fire clearance approval for use of the Narthex space. Fire clearance was approved by Dublin Fire Prevention Services on 1/26/2023.
Director will be sent an approved waiver and conditions of the waiver must be followed. Director also understands that LPA is to be updated if there is any change to the construction timeline. No deficiencies noted on today's date. Exit interview conducted with Director, Wazhma Masarweh. Notice of Site visit was provided.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023
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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