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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409646
Report Date: 12/31/2025
Date Signed: 12/31/2025 01:22:05 PM

Document Has Been Signed on 12/31/2025 01:22 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:HOLY SHEPHERD COMMUNITY PRESCHOOLFACILITY NUMBER:
073409646
ADMINISTRATOR/
DIRECTOR:		PETERSON, CLAIREFACILITY TYPE:
860
ADDRESS:433 MORAGA WAYTELEPHONE:
(925) 254-3429
CITY:ORINDASTATE: CAZIP CODE:
94563
CAPACITY: 63TOTAL ENROLLED CHILDREN: 63CENSUS: 12DATE:
12/31/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Claire PetersonTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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On 12/31/2025, Licensing Program Analyst (LPA), M. Domantay conducted an inspection and met with director Claire Peterson and toured the toddler program indoor and outdoor areas. The purpose of the visit was to conduct an inspection to add a toddler program. The facility has an existing preschool program facility #073400100 with a capacity of 63 preschool children. The applicant is requesting to be licensed for a total of 63 children, 39 preschoolers (ages 30 months to 5 years) and 24 toddlers (ages 18-29 months). Hours of operation will be Monday to Friday 8:30AM to 5:30PM. Fire clearance was granted and approved on 12/4/2025 from the Moraga-Orinda Fire District. Facility serves snacks for children and lunch is provided from home. Drinking water is available via filtered tap water and regular public tap water and children utilize personal water bottles.

LPA reviewed with director the LIC 311A, Records to be Maintained at the Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA informed Claire that the facility will be converted to a single child care center license under facility number 073409646, therefore LPA will be closing the current preschool facility number 073400100.



Toddler Indoor Classroom measurements are:
The Indoor total measurements contain a total of 935.49 square feet, which will accommodate Applicant's request for 24 toddlers.

INDOOR ACTIVITY SPACE:
There are 2 Toddler indoor classrooms: Room 4 (chickadees) and Room 5 (hummingbirds). LPA observed sufficient amount of equipment, toys, tables, mats, and chairs during today's inspection. Medications will be stored in each toddler classroom on the wall in a locked box. LPA observed a first aid kit in each toddler classroom. Page 1
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Melissa Domantay
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/31/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HOLY SHEPHERD COMMUNITY PRESCHOOL
FACILITY NUMBER: 073409646
VISIT DATE: 12/31/2025
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LPA advised Director that the following first-aid supplies in a location accessible to staff must be inaccessible to children: current edition of a first-aid manual, sterile first-aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometer, and antiseptic solution.

There are 3 toilets and 4 sinks designated for the toddler children to utilize in the toddler classrooms. There is a changing table in hands reach of a sink located in the bathroom area of Room 5. There is a separate private restroom for the staff is located in the facility.

The facility was observed to be clean, safe, sanitary and in good repair to ensure the safety and well-being of children and employees. LPA notified director a comfortable temperature for children shall be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts.

LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. LPA observed a combination smoke/carbon monoxide detector on the ceiling in the toddler classroom, Room 4. Director was not able to test carbon monoxide detector during the inspection due to detector being a combination with smoke detector, per Director it is up to code with the fire department. Per Director facility will utilize electronic sign-in/sign-out system. Children who become ill during the day will be isolated in the office or library area, LPA reminded Director a mat must be provided in the isolated area for children and will use the staff restroom, if necessary.



Toddler Outdoor Play Yard measurements are:

Outdoor total measurements contain a total of 1488.65 square feet, which will not accommodate Applicant’s request for 24 toddler children.

Applicant must submit a request for a waiver for the toddler play yard to be shared between toddler groups with a set schedule in place.



TODDLER OUTDOOR ACTIVITY SPACE:
There is 1 Toddler outdoor area at the facility, the toddler play yard. LPA inspected the toddler play yard. The toddler play yard is fully fence all around with metal linked fencing, and wooden fences, and metal door gate. There is a black metal door gate that is an exit with an alarm that sounds when pushed open. Page 2
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Melissa Domantay
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2025
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HOLY SHEPHERD COMMUNITY PRESCHOOL
FACILITY NUMBER: 073409646
VISIT DATE: 12/31/2025
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LPA observed tan bark and rubber matter surrounding areas of the play yard as cushioning to cushion a child's fall. LPA observed a sufficient amount of outdoor equipment and toys. LPA observed wooden play equipment that was observed to be age appropriate. LPA did not observe a manufacturer sticker on the wooden play equipment. LPA reminded Director to follow manufacturer guidelines for the toddler play equipment. There are no bodies of water on the premises. LPA reminded Director to ensure to empty all water tables when not in use. There is sufficient shading areas provided by trees and building awning. LPA observed a sandbox covered with tarp due to rainy weather in the toddler yard, LPA reminded Director to ensure to maintain and keep sandbox free of debris.

LPA reviewed with Applicants Section 101216.4 Preschool Program with Toddler Component. Toddlers may be enrolled into the program starting at age 18 months to a maximum of 36 months. LPA advised that children enrolled into the toddler program cannot be placed in the preschool program before the age of thirty (30) months without the written permission from the child's authorized representatives. LPA additionally advised that the toddler program shall be conducted in areas physically separated from those used by the preschool program and commingling shall not be permitted between components.

LPA advised that toddlers enrolled into the toddler component shall follow infant regulations, including nap check documentation and Infant Safe Sleep requirements, until they turn twenty four (24) months of age.

Drinking water from a non-contaminating fixture or container shall be readily available both indoors and in the outdoor activity area. Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code section 1597.16.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP.).

LPA referred licensee to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information)

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NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Melissa Domantay
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2025
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HOLY SHEPHERD COMMUNITY PRESCHOOL
FACILITY NUMBER: 073409646
VISIT DATE: 12/31/2025
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Applicants were reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (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

LPA discussed the safe sleep regulations with Applicants and discussed the Child Care Licensing Safe Sleep webpage at:https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPA also informed Applicants of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Applicants were informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

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NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Melissa Domantay
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2025
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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: HOLY SHEPHERD COMMUNITY PRESCHOOL
FACILITY NUMBER: 073409646
VISIT DATE: 12/31/2025
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If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

A notice of site visit was given to Director, Claire Peterson and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director Claire Peterson.

The following items are required before a license will be issued:



1. Licensing Program Manager (LPM) final file review.

2. Applicant must submit a request for a waiver for the toddler play yard to be shared between toddler groups with a set schedule in place.

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End of Report
NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Melissa Domantay
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/31/2025
LIC809 (FAS) - (06/04)
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