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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013417033
Report Date: 01/09/2023
Date Signed: 01/09/2023 12:07:59 PM

Document Has Been Signed on 01/09/2023 12:07 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:FREMONT PARENTS NURSERY SCHOOLFACILITY NUMBER:
013417033
ADMINISTRATOR:MILLER, JESSICAFACILITY TYPE:
850
ADDRESS:4200 ALDER AVENUETELEPHONE:
(510) 793-8531
CITY:FREMONTSTATE: CAZIP CODE:
94536
CAPACITY: 24TOTAL ENROLLED CHILDREN: 20CENSUS: 11DATE:
01/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Jessica MillerTIME COMPLETED:
12:15 PM
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On January 9, 2023 Licensing Program Analyst (LPA) Russ Haderer arrived unannounced at 11:35am to follow up on a complaint received on October 17, 2022 and met with site director Jessica Miller. Upon arrival there were two staff present (Jessica Miller and Kavitha Viswanathan), 5 parents and 11 children in care.

The complaint allegation that a child was injured while in care is substantiated, however, the facility is not being cited due to the fact the child caused their own injury by inappropriately operating a tricycle and ran into staff personnel.
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Russell Haderer
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2023
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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