013419400-11-28-2022-52-CC-KPHN-CLLR9K-20221128114940

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013419400
Report Date: 11/28/2022
Date Signed: 11/28/2022 11:49:50 AM

Document Has Been Signed on 11/28/2022 11:49 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 STE 1102
OAKLAND, CA 94612

FACILITY NAME:	SUNOL GLEN PRESCHOOL		FACILITY NUMBER:	013419400
ADMINISTRATOR:	COLLIER, KIRSTEN		FACILITY TYPE:	850
ADDRESS:	11601 MAIN ST.		TELEPHONE:	(925) 580-9306
CITY:	SUNOL	STATE: CA	ZIP CODE:	94586
CAPACITY:	24	CENSUS: 8	DATE:	11/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Kirsten Collier-Kotsakis		TIME COMPLETED:	12:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 11/28/2022 approximately at 9:00AM, Licensing Program Analyst (LPA) Kelly Phan met with Kirsten Collier- Kotsakis (Preschool Director) for an unannounced required 1 year inspection. Present for this inspection are 8 preschool aged children and two fingerprinted and associated staff members (two fully qualified preschool teachers). Facility operating hours are 8:30AM-3PM Monday -Friday. The facility was toured to conduct a health and safety inspection. At 9:15AM, LPA toured the facility classroom. This facility operates in a classroom #201 on the site of Sunol Glen Elementary School. The isolation area is located inside Sunol Glen Elementary school in the staff room. The classroom is tidy and clean with heating and ventilation for safety and comfort. There are safe age-appropriate toys and learning materials available to children throughout the classroom. There are also individualized storage space for each child's belongings. There were no hazardous materials and toxins present during today's inspection. Furniture accessible to children was observed to be age-appropriate, in operable condition, and free of loose, sharp, or pointed parts. There is a accessible sink in the classroom with plenty of soap and paper towels available. LPA reviewed sign in/sign out binder. There were 8 signatures out of 8 children present in the facility during today's inspection. There is a fully charged 2A10BC fire extinguisher, working telephone; carbon monoxide and smoke detectors are inspected by Fire Marshall every year per Kirsten (preschool director). The last date of a fire drill conducted was on 10/17/2022. All required documents are posted including a menu that is updated every month. Safe drinking water is available to children inside and outside the facility as children are using their own water bottles. Per Kirsten (preschool director), children are continuing to bring their own snacks and lunches or snacks are provided by the facility. LPA also reviewed one child's medications and documentation, which are in original containers, are not expired, and instructions are not altered. The facility also has an emergency disaster backpack including a first aid kit inside. SEE LIC 809 C

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2022

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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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: SUNOL GLEN PRESCHOOL	FACILITY NUMBER: 013419400
	VISIT DATE: 11/28/2022

NARRATIVE

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At 9:30AM, LPA also toured the facility bathrooms that are shared with Sunol Glen Elementary school. There were adequate amounts of paper towels and hand soap available to children in the bathroom, there were no cleaning supplies were observed to be accessible to children. The playground was also observed to be operable and age-appropriate during today's inspection. The playground is shared with other students of Sunol Glen Elementary School as well. Areas around swings, slides, and high climbing equipment have cushioning material to absorb falls. There are plenty of trees and canopy available to provide shade. There are no pools, hot tubs, ponds, or any other bodies of water.

At 10:00AM, LPA reviewed 6 children files and found that all files were complete. Three staff files were also reviewed and found that one staff file was missing the measles vaccine, which is one of the required immunizations as a preschool teacher. LPA advised the director to send proof of measles vaccine or immunity via email by 12/08/2022. Per Kirsten, the facility also had conducted their lead testing and will also send a copy of the sampling report to LPA via email. Facility roster was reviewed and a copy was obtained today.

There were no deficiencies were cited for today's inspection

Appeal rights and a notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00. Exit interview conducted and report was reviewed with facility director, Kirsten Collier-Kotsakis

Incidental Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. The facility is following and have developed IMS plan on file. When any changes to the IMS plan is made, an updated Plan for Providing 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)/ (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.”

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2022

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: SUNOL GLEN PRESCHOOL	FACILITY NUMBER: 013419400
	VISIT DATE: 11/28/2022

NARRATIVE

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Facility Representative was reminded that all adults 18 and over living or working in the home, 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 licensed Family Child Care Home. 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.

Facility Representative was reminded that California Law requires licensed Child Care Centers to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. LPA informed the Facility Representative that all forms can be downloaded at www.ccld.ca.gov and encouraged the Facility Representative to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. Licensee was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 622-2631
LICENSING EVALUATOR NAME: Kelly Phan	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 11/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/28/2022

LIC809 (FAS) - (06/04)

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