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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010210783
Report Date: 11/30/2023
Date Signed: 11/30/2023 11:43:39 AM

Document Has Been Signed on 11/30/2023 11:43 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:RESURRECTION LUTHERAN PRESCHOOLFACILITY NUMBER:
010210783
ADMINISTRATOR:WAZHMA MASARWEHFACILITY TYPE:
850
ADDRESS:7557 AMADOR VALLEY BOULEVARDTELEPHONE:
(925) 829-5487
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 30DATE:
11/30/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:director, Wazma MasarwehTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Jyoti Saini met with director Wazma Masarwah for an unannounced Annual Random Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by the director. In addition to the director, 30 children and six staff members are present today. The facility operates Monday - Friday from 7:30 am to 5:30 pm in room #1( AKA Owls), room #4 (AKA busy Bees), room #5 (AKA Tigers), and room# 6 AKA( superstars). The facility was inspected indoors and outdoors today for health and safety hazards, and the following was observed.
There is a working fire alarm system in the facility. The facility has a working smoke and carbon monoxide detector, a fully charged fire extinguisher, and a working telephone. No bodies of water, firearms, or weapons are on the premises. The Center is in good condition with proper temperature and ventilation, and is free of hazards. All furniture is in good repair. The Center has age-appropriate toys and equipment. A first aid kit and a first aid backpack are available. The outdoor play area is fenced for supervision. The play structure is age-appropriate and in good condition. There are separate bathrooms for the children and staff. The bathrooms are safe, sanitary, and free of any hazardous items. There is drinking water readily available for children. The facility refills the water bottles using water jugs/pitchers. Mats are available for use by children. The bedding is sent home weekly to be washed by the parents, and the facility also has a washer and dryer to wash the bedding if needed. Children bring their lunch from home, and the facility provides snacks. The classroom has appropriate postings. The last Emergency Drill was conducted on 11/03/2023 at 10:00 am and is properly logged.
The facility uses the Lillio app to sign in and sign out the children. The Center has a complete record of sign-in/out sheets by an authorized pick-up person. All the Children's records reviewed were complete. All children have a record of emergency identification information on file. All staff members have a criminal record clearance on file. The staff has a current Pediatric First Aid/CPR certificate and has taken Mandated Reporter training. The director understands that at least one person with valid CPR and First Aid certifications shall always be on-site or present during off-site activities (field trips). The facility roster was reviewed, and a copy was obtained.
see next page..
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: RESURRECTION LUTHERAN PRESCHOOL
FACILITY NUMBER: 010210783
VISIT DATE: 11/30/2023
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During inspection,

Criminal Record Clearance -Facility representative was reminded that all adults 18 and over, 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.

Lead Testing – CCC COMPLETED TESTING


Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
Incidental Medical Services (IMS)
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records.
For IMS information see PIN 22-02-CCP. 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 are available at: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org
Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No deficiency is cited today, however one technical violations was given.

A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with the facility representative, Wazma Masarwah.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
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