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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408936
Report Date: 10/13/2022
Date Signed: 10/13/2022 10:16:22 AM

Document Has Been Signed on 10/13/2022 10:16 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:CONTRA COSTA COLLEGE-EARLY CHILDHOOD LAB SCHOOLFACILITY NUMBER:
073408936
ADMINISTRATOR:AYALA, BRIANNEFACILITY TYPE:
830
ADDRESS:2600 MISSION BELL DRIVETELEPHONE:
(510) 215-3983
CITY:SAN PABLOSTATE: CAZIP CODE:
94806
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: DATE:
10/13/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Brianne AyalaTIME COMPLETED:
10:35 AM
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On 10/13/22 Licensing Program Analysts (LPAs) Melissa Guirit and Melissa Domantay conducted an unannounced case management inspection at the facility above in regard to unusual incident that occurred on 9/28/2022 where a child scraped his forehead, nose and upper lip trying to go through a playhouse window. LPAs met with Director, Brianne Ayala. Per Director, the playhouse was taken out and the child no longer attends the facility. A tour of the facility was conducted with Director and the playhouse is no longer there.

No deficiencies being cited today.

An exit interview was conducted with Director Brianne Ayala and report and notice of site was provided. Appeal rights provided.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Melissa Guirit
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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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