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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075700618
Report Date: 09/06/2024
Date Signed: 09/06/2024 01:43:33 PM

Document Has Been Signed on 09/06/2024 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KIDS' COUNTRY AT LIVE OAKFACILITY NUMBER:
075700618
ADMINISTRATOR/
DIRECTOR:		ROWENA ALEGREFACILITY TYPE:
860
ADDRESS:5151 SHERWOOD WAYTELEPHONE:
(925) 743-3186
CITY:SAN RAMONSTATE: CAZIP CODE:
94582
CAPACITY: 194TOTAL ENROLLED CHILDREN: 194CENSUS: DATE:
09/06/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Ann TanciocoTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes and met with Licensee Representative (LR) Ann Tancioco for the purpose of a pre-licensing inspection. LR requests a school-age license to serve 194 school-age children from transitional kindergarten and above. The program will operate Monday through Friday from 6:30 a.m. to 6:30 p.m. The fire clearance was granted and received on 8/2/2024. LPA observed a letter from the School District’s Assistant Superintendent on file allowing the program to utilize the childcare building and the multipurpose room (MPR) for the capacity requested.

The facility will be providing afternoon snack during the school year and lunch and snacks during holidays and summer. LPA reviewed with LR the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

INDOOR ACTIVITY SPACE:

The school-age children will be occupying the childcare building which has three classrooms and the MPR. LPA observed a sufficient amount of equipment, tables, chairs, and cubbies/hooks. Medication and first aid kit will be stored in the kitchen. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. LR stated there are no poisons or firearms on the premises. LPA observed a water fountains in each classroom. LPA observed a functional carbon monoxide detector in the hallway and kitchen. LPA observed an electronic sign-in/sign-out system.

Report continues on LIC809 page 2.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KIDS' COUNTRY AT LIVE OAK
FACILITY NUMBER: 075700618
VISIT DATE: 09/06/2024
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Page 2.

LR has requested a capacity of 194 school-age children. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, LPA did not take measurements. The children have access to all children's school restrooms located on campus, and a separate private restroom for the staff located in the hallway. Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:

There is one outdoor area on the property. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall. LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by overhangs, trees, canopies, and shade structures. Per Health and Safety Code 1596.806, the facility is exempt from square footage requirement; therefore, LPA did not take measurements.

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 following: supervision; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with LR any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Report continues on LIC809-C page 3.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
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 SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KIDS' COUNTRY AT LIVE OAK
FACILITY NUMBER: 075700618
VISIT DATE: 09/06/2024
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LR was 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.

LR was 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 platform. 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.

Exit interview conducted and report was reviewed with Licensee Representative (LR) Ann Ronita Tancioco.

LPA will issue a provisional license that will expire in 90 days on 12/5/2024. Once the provisional is issued, the following items are to be submitted prior to expiration of the provisional license for final approval of a regular license:

1. Final file review from Licensing Program Manager (LPM) Mai Lor.

2. Amended STD850 to include the rooms/buildings the school-age children will be utilizing.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC809 (FAS) - (06/04)
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