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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423124
Report Date: 10/29/2021
Date Signed: 10/29/2021 10:57:42 AM

Document Has Been Signed on 10/29/2021 10:57 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:BOULEVARD LITTLE PEOPLE PRESCHOOL ACADEMY LLCFACILITY NUMBER:
013423124
ADMINISTRATOR:LI, SHU JUNFACILITY TYPE:
850
ADDRESS:470 BOULEVARD WAYTELEPHONE:
(510) 832-2732
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
10/29/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Deltrina JohnsonTIME COMPLETED:
11:15 AM
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On 10/29/21 Licensing Program Analysts (LPAs) Melissa Guirit and Melissa Domantay arrived at the facility for an announced prelicensing inspection. LPAs met with the owner Deltrina Johnson. There were 3 additional staff and 8 children also present. An application was received for this facility to obtain a preschool license. There is another licensed facility located on the same grounds at 468 Boulevard Way. The facility will operate Monday-Friday 7:45am-5:30pm, utilizing 3 classroom areas, the kitchen, outdoor play space, and front lobby area. LPAs toured all areas that will be used by children, to conduct a health and safety inspection, and the measurements are as follows:

INDOORS: 742.67 square feet= 21 children
OUTDOORS: 7,904.94 square feet= 105 children
A fire clearance, with a total capacity of 14 children was received from the Oakland Fire Department.

LPAs 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 1 toilet and 1 sink available for children, and they are in sanitary and operational condition. There is a separate toilet and sink for staff. Both bathrooms are located where there are a washer and dryer present. LPAs observed a kitchen area that is clean and well equipped. The children will be utilizing the kitchen area to walk through to the bathroom area. LPAs reminded owner that children must be supervised at all times when being taken to the bathroom. LPAs 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. LPAs observed an ample supply of sleeping mats, which are stored appropriately. The facility will utilize an electronic sign in/out system.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2021
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 LITTLE PEOPLE PRESCHOOL ACADEMY LLC
FACILITY NUMBER: 013423124
VISIT DATE: 10/29/2021
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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. LPAs 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 play structure is in good condition and is on a padded rubber area. There are areas to provide shade for the children. No defects or dangerous conditions were observed on the playground.

Documents have been received and reviewed, to verify that Shu Jun Li is qualified as a preschool director. The COVID-19 self-assessment will be completed by the facility, and all required postings are available including ones with guidance and recommendations to limit the spread of COVID-19.

LPAs 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 will be effective as of today, 10/29/21. An exit interview was conducted, and a copy of the report was provided.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2021
LIC809 (FAS) - (06/04)
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