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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405693
Report Date: 06/10/2022
Date Signed: 06/10/2022 01:24:51 PM


Document Has Been Signed on 06/10/2022 01:24 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:MY SPANISH VILLAGEFACILITY NUMBER:
073405693
ADMINISTRATOR:LEON, GLADYS PEREZFACILITY TYPE:
850
ADDRESS:1924 TRINITY AVE.TELEPHONE:
(925) 286-4382
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY:59CENSUS: 59DATE:
06/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Gladys Perez LeonTIME COMPLETED:
01:30 PM
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On 6/10/22 at 10:45 am Licensing Program Analysts (LPAs) Monica Mathur and Christina Watts conducted an unannounced Annual Inspection at My Spanish Village. LPAs met with Director/Licensee, Gladys Perez Leon and her spouse, Robert and explained the purpose of today's inspection. Facility's operating days and hours are Monday to Friday from 8 am -- 5 pm in 1 Toddler Room (Red) and 7 Preschool Rooms. Program is located in the premises of St Paul's Episcopal Church. There is an active waiver to use church bathroom. This is a Spanish Immersion Program.

The physical plant was inspected. LPA toured the premises with the Director. Toddler room, 7 preschool rooms, restrooms, pantry, storage room, and office area were inspected. Facility was observed to be in compliance with teacher to children ratio requirement during inspection. Children were engaged in various activities under the visual supervision of the teachers. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair. LPA observed a working Fire extinguisher, Smoke and Carbon Monoxide Detectors. Last Fire Drill was conducted on 5/27/22. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles. Facility’s License, Parents’ Rights Poster PUB393, Personal Rights, Activity Schedules, and Menus were observed to be posted.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MY SPANISH VILLAGE
FACILITY NUMBER: 073405693
VISIT DATE: 06/10/2022
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Outdoor Space was inspected, there is 1 play ground for toddlers and another for preschoolers. It was observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. Shade is provided by way of trees and building overhangs. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.

File Review: Children sign in and out procedures and logs were reviewed. They use an electronic system SPLAN. A sampling of Children and Staff files was taken for review. All files contained required documents. There was at least one Teacher with current certification in Pediatric CPR/First Aid present at the facility during inspection. Children's Roster was reviewed, and a copy obtained. There was an adult ELENA PARRA MONTOYA present in the Rainbow room, helping with supervision and care with 2 other staff present and 11 children. She did not have fingerprint clearances, was not associated to this license or any prior associations to a child care facility. Gladys stated she is a prospective hire, is checking out the facility before being hired. She had been in the presence of children for 3 days. Type A deficiency with $300 civil penalty assessed today ($100 per day for 3 days). Adult left the premises immediately to get her Live Scan.

Director 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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)/ (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: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MY SPANISH VILLAGE
FACILITY NUMBER: 073405693
VISIT DATE: 06/10/2022
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LPA discussed the safe sleep regulations with Director 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 Director 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.

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.

In the areas that were evaluated, regulatory violation was observed. Citation was issued on 809D. At 1:30 pm Exit interview conducted and report was reviewed with the Director, Gladys Leon. A Notice of Site Visit was given and must remain posted for 30 days.

LPA Monica Mathur informed Director, Gladys Perez Leon that this report dated 6/10/22 with 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Mathur informed Director Gladys Leon to provide a copy of this licensing report dated 6/10/22 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 06/10/2022 01:24 PM - It Cannot Be Edited

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: MY SPANISH VILLAGE
FACILITY NUMBER: 073405693

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)(1)

Criminal Record Clearance 101170(e) All individuals subject to a criminal record review shall prior to working, risding,or volunteering in a licensed facility (1) obtain a California clearance or a criminal record exemption as required by the Department.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on file review, ELENA PARRA MONTOYA has been present with children in the classroom for 3 days, is not fingerprint cleared or associated to the license. She does not have any prior associations to any childcare facility. poses an immediate health, safety or personal rights risk to persons in care. Civil penalty of $300 assessed.
POC Due Date: 06/13/2022
Plan of Correction
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ELENA left the facility immediately for Live Scan. Director agreed to submit proof of live scan by end of 6/13/22 and a written statement of understanding of regulation and how facility will come in compliance.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sherelle JohnsonTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2022
LIC809 (FAS) - (06/04)
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