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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415043
Report Date: 06/23/2021
Date Signed: 06/23/2021 01:18:35 PM

Document Has Been Signed on 06/23/2021 01:18 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:OUR SAVIOR LUTHERAN EARLY CHILDHOOD DEV. CTR.FACILITY NUMBER:
013415043
ADMINISTRATOR:HALL, SARAFACILITY TYPE:
850
ADDRESS:1385 SO. LIVERMORE AVENUETELEPHONE:
(925) 455-5437
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 85TOTAL ENROLLED CHILDREN: 0CENSUS: 14DATE:
06/23/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:51 AM
MET WITH:Sara HallTIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Melanie Otsuji conducted an announced Case Management Inspection. LPA was met by Director/Applicant, Sara Hall. Present during today's visit were 14 preschool aged children and 4 staff members. The center has submitted an application for a CAPACITY INCREASE AND ROOM ADDITION. The facility is adding room BUILDING A, ROOM 3A on the campus of OUR SAVIOR LUTHERAN MINISTRIES. Facility is currently requesting to increase from 85 preschoolers to 97 preschoolers. A health and safety inspection was conducted inside and outside. Facility days and hours of operation are Monday through Friday 7:00AM-5:30PM. The facility measurements are as follows:

INDOORS: 5461.94 SQUARE FEET = 156 CHILDREN
OUTDOORS: 8180.50 SQUARE FEET = 109 CHILDREN

The center has obtained an approved fire clearance from Livermore-Pleasanton Fire Dept on 5/26/2021. Our Savior Lutheran Early Childhood Dev. Center will have 7 approved PRESCHOOL classrooms (Bldg D Rooms 1, 2, 3, 4 and central space, Bldg F Nursery Room, and Bldg A Room 3A). Facility will also have one play yard for preschool aged children. Preschool rooms are equipped with varied age appropriate materials and equipment. There are 7 toilets and 9 sinks available for children use. The staff have a separate bathroom in the office which will also serve as an isolation bathroom. The office will serve as an isolation room for sick children. Individual Medical Services (IMS) policy was discussed. When any changes to IMS are made, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2021
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: OUR SAVIOR LUTHERAN EARLY CHILDHOOD DEV. CTR.
FACILITY NUMBER: 013415043
VISIT DATE: 06/23/2021
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All licensing required documents are posted. Zero Tolerance policies were explained. Notice of Site Visit form was provided and posted. The center was found to be clean, safe, sanitary and in good repair. There were no deficiencies cited during this visit.

A license for 97 preschool aged children operating out of 7 rooms (Bldg D Rooms 1, 2, 3, 4 and central space, Bldg F Nursery Room, and Bldg A Room 3A) will be issued today, effective 6/23/2021.

An exit interview was conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC809 (FAS) - (06/04)
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