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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423117
Report Date: 05/25/2021
Date Signed: 05/25/2021 01:06:31 PM

Document Has Been Signed on 05/25/2021 01:06 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:BOULEVARD ACADEMYFACILITY NUMBER:
013423117
ADMINISTRATOR:LI, WAN BINGFACILITY TYPE:
850
ADDRESS:468 BOULEVARD WAYTELEPHONE:
(510) 832-0132
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 12DATE:
05/25/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Deltrina JohnsonTIME COMPLETED:
01:15 PM
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On 5/25/21 at 10am Licensing Program Manager (LPM) Loretta Dyson arrived at the facility for an announced prelicensing inspection. LPM met with the owner Deltrina Johnson. There were 3 additional staff and 12 children also present. An application was received for this facility to obtain a preschool license, with toddler option. The facility is currently licensed as a large family child care home, and this will be closed once the preschool license is approved. The facility will operate Monday-Friday 8am-5:30pm, in one large room that will be divided into two spaces. LPM toured all areas that will be used by children, to conduct a health and safety inspection, and the measurements are as follows:

INDOORS: 542.34 square feet= 16 children
OUTDOORS: 1,819.72 square feet= 24 children
A fire clearance, dated 3/22/21, with a total capacity of 14 children, including 8 preschoolers and 6 toddlers, was received from the Oakland Fire Department.

LPM observed that the spaces have sufficient lighting, heating and ventilation for the safety and comfort of children and staff. The floors and surfaces are clean and in good condition. There is an ample supply of age appropriate activities, equipment, toys and furniture that is in good condition. There is a total of 2 toilets and 2 sinks available for children, and they are in sanitary and operational condition. There is a separate bathroom for staff. There is a laundry/storage room, which will be inaccessible for children. LPM observed that the kitchenette area is clean and is well equipped. LPM did not observe any cleaning supplies stored with food. There is a menu posted that is dated at least a week in advance. Children will have individual cups or water bottles, which will be refilled by staff as needed, to provide water both indoors and outdoors. The facility serves low fat milk to children. LPM observed an ample supply of sleeping mats, which are stored appropriately. The facility will utilize an electronic sign in/out system.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2021
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: BOULEVARD ACADEMY
FACILITY NUMBER: 013423117
VISIT DATE: 05/25/2021
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The facility is equipped with a 3A40BC fire extinguisher, a centralized smoke detection system, working carbon monoxide detector, telephone, and first aid supplies. LPM did not observe any hazardous items, toxins, bodies of water or medication accessible to children today.

The outdoor play area is fully fenced and there is an ample supply of toys, equipment and activities available and they are in good condition. The outdoor play area will be shared between the toddlers and preschoolers, and a waiver request for the outdoor play area will be submitted. There are canopies above the play areas to provide shade. No defects or dangerous conditions were observed on the playground.

Documents have been received and reviewed, to verify that Wan (Wendy) Bing Li is qualified as a preschool director. There are a few documents that are still needed and LPM provided a list to the owner. The COVID-19 self-assessment has been completed by the facility and reviewed, and all required postings are available including ones with guidance and recommendations to limit the spread of COVID-19.

LPM reviewed the Incidental Medical Services (IMS) policy. 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 owner was advised to review information related to applicable regulations on Licensing’s website at www.ccld.ca.gov. LPM reminded the applicants and director to adhere to all requirements within the regulations at all times including supervision, personal rights, ratio, unusual incident and injury reporting, and criminal record clearance and association requirements. The owner was encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The owner was reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

The preschool license, with a capacity of 14 including up to 6 toddlers with the toddler option, will be effective once all items listed on the Notice of Incomplete Application are received. This report will remain on file for 3 years. An exit interview was conducted, and a copy of the report was provided.
SUPERVISORS NAME: Diane Perez
LICENSING EVALUATOR NAME: Loretta Dyson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021
LIC809 (FAS) - (06/04)
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