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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422001
Report Date: 09/17/2024
Date Signed: 09/17/2024 03:42:32 PM

Document Has Been Signed on 09/17/2024 03:42 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:DAVIS STREET CDC @ LAKESIDEFACILITY NUMBER:
013422001
ADMINISTRATOR/
DIRECTOR:
MURILLO, TRISHFACILITY TYPE:
850
ADDRESS:3000 WATERFALL WAYTELEPHONE:
(510) 351-5156
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
09/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Daisy AmezcuaTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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On September 17,2024 at 1:30 PM, Licensing Program Analyst (LPA) Michael Mathew conducted an announced case management inspection to change facility from inactive to active. LPA met with executive director Daisy Amezcua and advised her the purpose of the inspection. LPA was provided a tour of the facility inside and out. There were 0 children in care and 2 staff at the time of the inspection.

Facility was inactive on 5/31/24 due to Covid. LPA took a tour of the facility with executive director Daisy Amezcua; facility has one classroom and one bathroom with two sinks and two toilets. the outdoor play area has ample amount of space for children to play. LPA observed rubber padding under the play structure to help protect the children when they fall. LPA observed a pool next to the facility. Executive director Daisy Amezcua, stated that the facility will not be using the pool at all and children will not have have access to the pool. LPA observed a gate separating the pool from the classroom. Executive director Daisy Amezcua stated that facility will be providing morning and afternoon snack and lunches will be brought from the children's home. Fire alarm and carbon monoxide detectors are good an working condition.

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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 is now on active status as of today 9/17/24.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with executive director Daisy Amezcua

No deficiency was cited in today’s visit.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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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