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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420903
Report Date: 08/01/2023
Date Signed: 08/01/2023 03:45:44 PM

Document Has Been Signed on 08/01/2023 03:45 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:EXTENDED DAY CHILD CARE - EDCC - KOLB ELEMENTARYFACILITY NUMBER:
013420903
ADMINISTRATOR:TAMARA BRELLANDFACILITY TYPE:
840
ADDRESS:3150 PALERMO WAYTELEPHONE:
(925) 828-2666
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 77DATE:
08/01/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:29 PM
MET WITH:Carrie KnollmillerTIME COMPLETED:
03:55 PM
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A Case Management Visit was conducted on this date 8/1/2023 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA met with Lead Teacher, Carrie Knollmiller. An application was submitted for an Addition of a Room and Removal of a Room with no change to capacity. The center has requested to add ROOM L2 (portable on backside of campus) as licensed space and remove ROOM B1. The school age program is located on Kolb Elementary School campus. The program is currently utilizing Rooms B1, EDCC BUILDING and MULTI-PURPOSE ROOM on school grounds. Hours of operation are from 7:00AM to 6:00PM Monday through Friday. Present today were 9 staff members and 77 children. A health and safety inspection was conducted inside and outside.

INDOORS: EXEMPT
OUTDOORS: EXEMPT

Facility utilizes Kolb Elementary playground structures, blacktop and grassy area and does not commingle with the elementary school children. Drinking water is available inside and outside by way of water fountains and bottles brought from home. Facility provides AM/PM snacks. Menus are posted. Lunch is brought from home. Facility has a functioning carbon monoxide detector, smoke detector and fire extinguisher. Facility has an electronic sign in/out program that grants each authorized representative a unique identifier. Sign in/out logs were checked and matches current census. Per facility representative, all Opening and Closing staff have current Pediatric CPR/First Aid. Playground equipment is in good condition.

The center has received an approved fire clearance from Dublin Fire Prevention Services on 7/27/2023. Per 850 approval, capacity maximum for L2 is 46.

All licensing required documents are posted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: EXTENDED DAY CHILD CARE - EDCC - KOLB ELEMENTARY
FACILITY NUMBER: 013420903
VISIT DATE: 08/01/2023
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This facility plans to provide Incidental Medical Services – IMS. An updated Plan of Operation that includes IMS must be submitted to the Department when any changes are made. 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.

The center was found to be clean, safe, sanitary and in good repair.

There are no deficiencies cited during today's visit. A license approving 120 school aged children and use of Room L2 (max capacity 46) and previously licensed space Multi-purpose Room, EDCC Room and school playground is effective on today's date, 08/01/2023.

An exit interview was conducted with Lead Teacher, Carrie Knollmiller.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC809 (FAS) - (06/04)
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