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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010212589
Report Date: 06/28/2023
Date Signed: 06/28/2023 11:30:50 AM

Document Has Been Signed on 06/28/2023 11:30 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:FREMONT CHRISTIAN PRESCHOOLFACILITY NUMBER:
010212589
ADMINISTRATOR:JIMENEZ, NATHANIELFACILITY TYPE:
850
ADDRESS:4760 THORNTON AVENUETELEPHONE:
(510) 744-2260
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 197TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/28/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Nathaniel JimenezTIME COMPLETED:
11:30 AM
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On June 28, 2023 Regional Manager Anika Evans, and Licensing Program Analyst Russell Haderer met with Site Director Nathaniel Jimenez for a Non-Compliance meeting to discuss previous Type A citations that were issued to the facility.

Licensee was issued a childcare license effective March 1993. Unusual incident reports and Complaints have been reported to Licensing and investigated. The facility has been found to be out of compliance with regard to Lack of Supervision and Personal Rights and issued Type A deficiencies. Recently Lack of supervision occurred on 05/12/2023 and 04/07/2022; Recent Personal rights violation occurred on 09/01/2022.

During the meeting it was determined that a civil penalty of $500 will be issued for the Type A deficiency (this should have been issued during the June 14, 2023 visit); the child care facility will be placed on required visits to ensure compliance; technical support is offered by TSP unit staff member Christopher Jackson; Licensee form LIC9224 will be required to be signed by parents of each current child enrolled and for future children enrolling for the next 12 months and kept in the child's file for review by licensing.

Report was read to licensee and signature was obtained.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2023
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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