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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010210783
Report Date: 05/23/2023
Date Signed: 05/23/2023 04:36:47 PM

Document Has Been Signed on 05/23/2023 04:36 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 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: 45DATE:
05/23/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:43 PM
MET WITH:Wazhma MasarwehTIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced to conduct a Case Management - Licensee Initiated inspection. LPA met with Director, Wazhma Masarweh. Also present during today's visit were 6 additional staff members and 45 preschool aged children.

Facility has submitted an application to add back previously licensed rooms. On January 30, 2023 Classroom 4 & 5 were temporarily removed and Narthex was added due to Winter Storm damage. Construction within classrooms 4 & 5 is now complete. LPA toured the facility for a health and safety inspection. There has been no changes to square footage within the facility. Facility currently has 8 sinks and 6 toilets available for children use. LPA observed fully charged fire extinguishers, functioning carbon monoxide detector and smoke detectors within the facility.

Facility received an approved fire clearance from Dublin Fire Prevention Services on 5/22/2023.

There are no deficiencies noted on during LPA's inspection. Facility will now be able to utilize Classrooms 4 & 5 as of today's date, 5/23/2023. Director is aware that facility must now seize operation within the Narthex.

Notice of Site Visit will be provided. Exit interview conducted and report reviewed with Director, Wazhma Masarweh.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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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