073407443-2-4-2020-02-CC-PPEN-BLGRFK-20200204115916

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073407443
Report Date: 02/04/2020
Date Signed: 02/04/2020 11:59:40 AM

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:	ST. PAUL PRESCHOOL		FACILITY NUMBER:	073407443
ADMINISTRATOR:	LENZ-ACUNA, NATALIE		FACILITY TYPE:	850
ADDRESS:	1825 CHURCH LANE		TELEPHONE:	(510) 233-3080
CITY:	SAN PABLO	STATE: CA	ZIP CODE:	94806
CAPACITY:	21	CENSUS: 5	DATE:	02/04/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Virginia Garcia		TIME COMPLETED:	12:05 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	Licensing Program Analyst (LPA) Paul Petersen conducted an annual random site inspection for this facility at 0925. LPA met with site supervisor, Virginia Garcia, who was present along with one additional teaching staff (qualified teacher) and five preschool age children in care. The facility is within ratio and capacity and children are supervised at all times. All adults present at this program are background cleared and associated. LPA toured all areas licensed for use by this preschool program. The program is located in one classroom (Preschool Classroom) on the grounds of St. Paul School. The classroom has age appropriate furnishings and equipment which are free of broken/sharp pieces. There is a working smoke/fire alarm and carbon monoxide detector. Counters and surfaces, including floors, are free of toxins and observed hazardous conditions. There are no hazardous items/toxins observed to be accessible to children in care. There is a fully charged fire extinguisher and per director, the most recent fire department inspection was within the past year. Per director, there are no firearms present or stored on the premises. Indoor drinking water is available via individual children's drinking cups. Outdoor drinking water is available by working water fountains and individual children's cups. Children bring their own meals and snacks from home. There is napping equipment available for children and children's napping linens/bedding is stored separate for individual child use and laundered at least weekly. The outdoor play area is fully fenced and designated for preschool use only so that preschool children do not commingle with older age group children. There is one piece of high climbing equipment/slide which is securely anchored with cushioning under/around the structure. There are no pools or other bodies of water accessible to children. The preschool children use the school children's bathrooms with staff supervision present at all times to ensure that preschool children do not use the bathrooms at the same time as older age children. There is a waiver on file for use of the school bathrooms. Continued on Page 2**************************************************************************************

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020

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: ST. PAUL PRESCHOOL	FACILITY NUMBER: 073407443
	VISIT DATE: 02/04/2020

NARRATIVE

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Children's files were reviewed for immunization records, parents' rights forms and identification and emergency information forms.

Staff records were reviewed for teacher qualifications, CPR/First Aid certification and immunization records. Teacher qualification form was completed for one staff during this inspection. Both staff present have current CPR/First Aid certification. The facility sign in/sign out records are current and accurate. All required postings are present including one waiver.

Facility Staff are encouraged to visit www.ccld.ca.gov for licensing updates and forms. Contact: ChildCareAdvocatesprogram@dss.ca.gov to sign up for quarterly updates. Staff are also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com. Facility administrator was provided with CDSS Effects of Lead Exposure Informational and lead testing requirements were discussed.

This facility provides Incidental Medical Services-IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual-Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information 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

There were no deficiencies cited during this inspection. A notice of site visit was provided and is to be posted for 30 days. A copy of this report was provided and is to be kept in the facility records for a period of three years.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Paul Peterson	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020

LIC809 (FAS) - (06/04)

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