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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415043
Report Date: 05/12/2023
Date Signed: 05/18/2023 03:14:28 PM

Document Has Been Signed on 05/18/2023 03:14 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:OUR SAVIOR LUTHERAN EARLY CHILDHOOD DEV. CTR.FACILITY NUMBER:
013415043
ADMINISTRATOR:ANNAMARIE BUYERFACILITY TYPE:
850
ADDRESS:1385 SO. LIVERMORE AVENUETELEPHONE:
(925) 455-5437
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 97TOTAL ENROLLED CHILDREN: 97CENSUS: 66DATE:
05/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Brittani YoungTIME COMPLETED:
12:45 PM
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On May 12, 2023, Licensing Program Analysts (LPAs) Simerjit Kaur and Julie Palcencia conducted an UNANNOUNCED ANNUAL REQUIRED INSPECTION and met with facility staff Brittani Young and Ryann Ness. The facility was toured to conduct a Health and Safety Inspection. Present the inspection were 15 staff and 66 children. The facility is within ratio and capacity compliance today. The facility operates from September - June and Monday - Friday from 7:00am - 5:30pm.
The preschool is located on the campus of Our Savior Lutheran School (TK through 8th grade). The preschool operates out of 2 buildings and 5 classrooms. The classrooms are Buddy Bears, Rising Stars, Friendly Frogs, Wonderful Whales are located in preschool building. Little Lams located in the school building. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the inspection. Furniture and equipment are in good condition, and floors are free of tripping hazards. All storage containers for solid waste have tight-fitting covers that are in good repair. Drinking water is available both indoors and outdoors. There are no pools or similar bodies of water at this facility. Outdoor activity space and playground equipment observed to be safe and free of hazards. There is a shaded area provided for the children. LPAs observed working carbon monoxide detector and a fully charged fire extinguisher. Smoke detectors and fire alarms inspections are conducted by Bay Alarm.

All required postings are posted. The children bring their own lunch and AM/PM snacks. Per facility staff, there are no firearms present on the premises. A copy of the children’s roster was obtained. LPAs reviewed children and staff files. LPAs reviewed staff files and qualified teachers. The opener, and the closer staff have current CPR/First Aid certificates. Sign in/out logs are maintained.

Continue on LIC 809-C

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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: OUR SAVIOR LUTHERAN EARLY CHILDHOOD DEV. CTR.
FACILITY NUMBER: 013415043
VISIT DATE: 05/12/2023
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Facility represenative.,;., was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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 Evaluator Manual – Regulation Interpretations and Procedures for Child Care Center Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.


To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Simerjit Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC809 (FAS) - (06/04)
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