<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420979
Report Date: 08/06/2024
Date Signed: 08/06/2024 01:03:39 PM

Document Has Been Signed on 08/06/2024 01:03 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ALA COSTA CENTER - ALAMEDA SITEFACILITY NUMBER:
013420979
ADMINISTRATOR/
DIRECTOR:		BENNETT, MARGIEFACILITY TYPE:
840
ADDRESS:1422 BUENA VISTA AVENUETELEPHONE:
(510) 527-2550
CITY:ALAMEDASTATE: CAZIP CODE:
94501
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 0DATE:
08/06/2024
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Michael PereiraTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On Tuesday August 6, 2024, Licensing Program Analysts (LPAs) M. Domantay and Diana Campos met with Executive Director, Michael Pereira, for the purpose of an announced case management inspection for an application that was submitted to change the capacity to increase the facility capacity to 22 School Age children and place back on active status. Present during today's inspection was Executive Director Michael Pereira. There were no children upon arrival. Hours of operation are Monday through Friday regular day from 2:00 PM to 6:00 PM, school minimum day from 12:30 PM-6:00 PM, long days/school breaks 9:00 AM to 6:00 PM. The fire clearance was granted on 2/29/2024.

LPAs toured the school age area with Executive Director. The program operates in 1 classroom, Classroom 1. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers and were in good repair. LPAs observed a combination smoke and Carbon Monoxide Detectors.

LPA measured 1 school age classroom. The total classroom space contains a total of 867.06 square feet, which will accommodate Applicant's request for 22 school age children. There is 1 toilet and 1 sink designated for the children to use and a second bathroom that is a public bathroom with 1 toilet and 1 sink that is available for staff that they are encouraged to use. Facility can only be approved and licensed for 15 school age children because of the bathroom availability of 1 sink and 1 toilet for children to utilize. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the Director's office and will use the staff restroom, if necessary.
Page 1
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: ALA COSTA CENTER - ALAMEDA SITE
FACILITY NUMBER: 013420979
VISIT DATE: 08/06/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Executive Director is requesting if public bathroom can be utilized by children if they are able to obtain a letter from the city giving the program strict access to public bathroom during their operating hours, which would restrict public use during operational hours. LPA is pending approval by Licensing Program Manager (LPM) Mai Lor and Regional Manager (RM) Michael Durante if this is a possibility for the program.

There is 1 outdoor area on the property for the school age children to utilize. Outdoor playground was inspected and observed to be safe. Executive Director is reminded that 100% supervision of children must be provided. All climbing equipment is properly anchored to the ground with adequate and appropriate cushioning under them. The playground is cushioned by rubber matting. There are shaded areas supplied by trees and canopies. The playground is free of debris and other hazards. There are no pools, hot tubs, or other bodies of water present. All measurements remain the same from previous inspections.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms.
To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

A notice of site visit was given to Executive Director, Michael Pereira and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Exit interview conducted and report was reviewed with the Executive Director, Michael Pereira.

The following items are required before a license will be issued:

1. Licensing Program Manager (LPM) final file review
2. Applicant must submit documentation from the City giving program strict access to public bathroom for program during operational hours and would restrict public use during operational hours.
3. Applicant must submit waiver for children and staff to share bathroom.

Page 2
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2