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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073400100
Report Date: 06/01/2023
Date Signed: 06/01/2023 02:37:48 PM

Document Has Been Signed on 06/01/2023 02:37 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:HOLY SHEPHERD CHRISTIAN PRESCHOOLFACILITY NUMBER:
073400100
ADMINISTRATOR:KOEPER, SUSANFACILITY TYPE:
850
ADDRESS:433 MORAGA WAYTELEPHONE:
(925) 254-3429
CITY:ORINDASTATE: CAZIP CODE:
94563
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 0DATE:
06/01/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Claire PetersonTIME COMPLETED:
01:45 PM
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A Case Management Visit was conducted on this date 6/1/23 by Licensing Program Analysts (LPAs), Melissa Domantay and Melissa Guirit. LPAs met with Director Claire Peterson. The center has submitted an application for a capacity increase, change within corporation, facility name change, and hours of operation change under the preschool license. Hours of operation are from 7:30am-6:00pm, Monday through Friday. A health and safety inspection was conducted inside and outside. Measurements are as follows:

Indoors: 2,523.29 square feet equals to 72 children
Outdoors: 3,777.27 square feet equals to children 50

A fire clearance was received from the Moraga-Orinda Fire District dated 5/23/2023 for 53 preschoolers, ages 2 years to first grade entry. Total capacity 53.

Playground equipment is in good condition. LPAs observed the outdoor play areas, which is fully fenced. LPAs observed play structures which can be utilized by children. There is sufficient cushion to absorb a child's fall under the play areas. There is a sandbox that is observed to be well maintained. LPAs observed ample amount of shade for children. Director will submit a request for a waiver for the outdoor play yard to ensure there are no more than 50 children at any given time.

Children will utilize personal reusable water bottles, with water still accessible to children inside and outside. There are 7 sinks and 5 toilets available for children's use. All toilets and hand-washing facilities are in safe and sanitary operating conditions. Menus are posted. Facility will provide morning snack and afternoon snacks. Lunch is provided from home. Facility will utilize electronic sign in/out. Facility has a functioning carbon monoxide detector that is connected to the main smoke detector system.

The center is equipped with a fully stocked first aid kit, working telephone, and 3A40BC fire extinguisher inside preschool classrooms. The fire system is hardwired.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/01/2023
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: HOLY SHEPHERD CHRISTIAN PRESCHOOL
FACILITY NUMBER: 073400100
VISIT DATE: 06/01/2023
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Director Claire was reminded that all adults 18 and over, 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.

A license for 53 preschoolers is effective today, 6/1/23 with a total capacity of 53 and is ready to be used when facility is ready. A notice of site visit was given and must remain posted for 30 days



Exit interview conducted and report was reviewed with the Director Claire.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC809 (FAS) - (06/04)
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