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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270710326
Report Date: 12/11/2019
Date Signed: 12/11/2019 02:40:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:APPLE PIE SCHOOLFACILITY NUMBER:
270710326
ADMINISTRATOR:VICKI BRIESACKERFACILITY TYPE:
850
ADDRESS:CA 1 AT CAPTAIN COOPER SCHOOLTELEPHONE:
(831) 667-2921
CITY:BIG SURSTATE: CAZIP CODE:
93920
CAPACITY:20CENSUS: 13DATE:
12/11/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Margaret LopezTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joe Macias conducted a Case Management Inspection. The purpose of today’s inspection is to ensure the facility is in compliance with Title 22 California Code of Regulations. LPA met with the Head Teacher Margaret Lopez, and explained the nature of today's visit. LPA toured the Facility both inside and outside during todays visit. LPA noted the center is located on the Captain Cooper Elementary School campus. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), and Activity Schedule. The hours of operation are Monday - Friday, 8:30am - 4pm.

While conducting a Random Annual Inspection on August 14, 2019 LPA observed missing fire extinguisher in the classroom. LPA did not receive the plan of correction by or before August 16, 2019. Upon arrival today LPA observed a fully charged 2A10BC fire extinguisher, that has been recently serviced. LPA reminded the Director of the importance of maintaining a fully charged fire extinguisher on site at all times.

No deficiencies cited, exit interview conducted, and a copy of this report was left at the facility.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
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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