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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013422001
Report Date: 10/03/2024
Date Signed: 10/03/2024 10:50:17 AM

Document Has Been Signed on 10/03/2024 10:50 AM - 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: 0CENSUS: 0DATE:
10/03/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:28 AM
MET WITH:Daisy Amezcua- Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 10/3/24, Licensing Program Analyst (LPA) Briana Plumboy met with Director Daisy Amezcua for an UNANNOUNCED ANNUAL REQUIRED INSPECTION. This childcare center is located in the clubhouse building at Lakeside Village Apartments. The program runs out of a classroom within the clubhouse building. LPA toured the facility for a Health and Safety Inspection. The facility was on inactive during the COVID 19 pandemic, and was placed back to active status on 9/17/24. This preschool program will be operating Monday to Friday 7:00 AM – 6:00 PM.

There is one (1) classroom and one (1) bathroom being utilized at the center by children. The bathroom has 2 sinks and 2 toilets. The facility is in good repair. CLASSROOM: There is adequate play and learning materials available. Classroom furniture and equipment is age appropriate and in good repair. There is adequate heating, ventilation and lighting. Drinking water is available inside and outside of the center. There is a working telephone on site. There are individual storage spaces for each child's belongings. Napping materials and equipment are properly labeled and stored appropriately. There are separate bathrooms for staff and children. There is a carbon monoxide detector, smoke detector, fully charged fire extinguisher, and pull-down alarm devices at the facility. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the visit. There are no bodies of water accessible to children being observed during the inspection. The outdoor play space is safe with cushioning and anchored play structures.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. 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
***See LIC 809C for Continuance***
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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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: DAVIS STREET CDC @ LAKESIDE
FACILITY NUMBER: 013422001
VISIT DATE: 10/03/2024
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Licensee is reminded that ALL Staff must be fingerprint cleared and associated prior to being in the presence of children in care, or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

LPA informed Director of Assembly Bill 1207, the mandated reporter training which can be found at www.mandatedreporterca.com.

For licensing updates email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates.

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 deficiencies were cited during today's inspection.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Briana Plumboy
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
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