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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700550
Report Date: 12/13/2021
Date Signed: 12/13/2021 01:43:59 PM

Document Has Been Signed on 12/13/2021 01:43 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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:PILGRIM LEARNING ACADEMYFACILITY NUMBER:
015700550
ADMINISTRATOR:VERVILLE, SHELLYFACILITY TYPE:
850
ADDRESS:20613 STANTON AVENUETELEPHONE:
(510) 581-1580
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 0DATE:
12/13/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Shelly VervilleTIME COMPLETED:
02:03 PM
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A Prelicensing inspection was conducted today 12/13/2021 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA met with Applicant/Director, Shelly Verville. The applicant has submitted an application for a CHANGE in OWNERSHIP for a PRESCHOOL license for 54 preschool aged children. The program will operate from 7:00AM - 6:00PM, Monday through Friday, in 3 classrooms. A health and safety inspection was conducted inside and outside and the measurements for preschool component are as follows:

INDOORS: 2493.19 square feet = 71 children
OUTDOORS: 11889.50 square feet = 159 children

The center has obtained an approved fire inspection clearance from the Alameda County Fire Department on 12/3/2021 for a capacity of 54 preschool aged children.

The preschool rooms are equipped with varied age appropriate materials and equipment. There are 5 toilets and 5 sinks available for children. Staff toilet is located in the Director's office. The facility has a kitchen and no cleaners or toxic materials were observed stored with food. Children will bring lunch from home. Facility will provide AM/PM snacks. The Director's office and staff bathroom will serve as isolation areas for sick children. Children have access to water inside and outside by way of water bottles brought from home and water fountains to refill should they run out.

This facility plans to provides Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following 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
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2021
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: PILGRIM LEARNING ACADEMY
FACILITY NUMBER: 015700550
VISIT DATE: 12/13/2021
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The play yards are fenced in all around. Building overhang provide sufficient shade in the play yard. There is a microwave and refrigerator available. First aid supplies are available in the center. There is a working telephone on site. Carbon monoxide detector is available and operable. Facility will be utilizing electronic sign in/out which each authorized representative has a unique identifier.

Shelly Verville is a fully qualified preschool director and a complete director's packet has been received.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter (GENERAL) AND (CHILD CARE PROVIDER) training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

The Department has implemented a new software system called Guardian, and it is encouraged to set up an account. This will enable you to perform associations/disassociations, initiate background checks, check clearances, and print and download rosters without having to contact an analyst. For questions or concerns relating to Guardian, please contact their help desk at guardian@dss.ca.gov or call at (888) 422-5669.

Frequently Asked Questions regarding Guardian:


https://cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian-faqs
Guardian for Agencies (instructional videos):
https://cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian


Zero Tolerance policies were explained. The center was found to be clean, safe, sanitary, and in good repair.

A license for 54 preschool aged children operating out of 3 classrooms and 2 play yards will be issued on today's date, 12/13/2021.
An exit interview was conducted.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
LIC809 (FAS) - (06/04)
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