270710406-9-29-2021-07-CC-ELAS-C7BN3P-20210929100637

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 270710406
Report Date: 09/14/2021
Date Signed: 09/29/2021 10:06:49 AM

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:	SHERWOOD STATE / MIGRANT PRESCHOOL CHILD CARE		FACILITY NUMBER:	270710406
ADMINISTRATOR:	GONZALEZ, ERNESTO		FACILITY TYPE:	850
ADDRESS:	110 SOUTH WOOD STREET		TELEPHONE:	(831) 784-5402
CITY:	SALINAS	STATE: CA	ZIP CODE:	93905
CAPACITY:	44	CENSUS: 12	DATE:	09/14/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Claudia Cardenas & Denise Noel		TIME COMPLETED:	01:50 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) Elizabeth Larios conducted an unannounced Case Management - Incident Inspection at the facility today. Upon arrival, LPA observed twelve (12) preschool age children and two (2) teachers and one (1) volunteer engaging in daily activities and met with Claudia Cardenas, Teacher. The purpose of the inspection was to review an incident that occurred at the facility on 8/30/2021 involving a child (C-1) and an absence of supervision. The facility self reported this incident on 9/01/2021, which was received by Community Care Licensing on the same date. LPA has confirmed that the facility has met reporting requirements for incident reporting. On 8/30/2021 child (C-1) walked out onto the side walk located in the school parking lot near the fence of the school. Child (C-1) was left without direct supervision for a short period of time. Child (C-1) was not injured during this incident. At the time of the inspection, LPA and the teacher including Preschool Program Coordinator discussed facility protocols and procedures in detail. LPA has conducted staff interviews and observed certain areas of the facility. A Notice of Site Visit has been issued and must remain posted for 30 consecutive days. A Deficiency has been cited as a result of today's inspection. Please refer to page 809-D for citation, description, and plan of correction. Per 101197 (a) Civil Penalties shall not be assessed against any governmental entity including a state or city, holding a child care center license. LPA discussed the requirements of AB633 to Claudia & Denise and provided a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and both understand the requirements. Exit interview conducted with Claudia Cardenas, Teacher and Denise Noel, Preschool Program Coordinator where this report was reviewed and a copy of appeal rights was provided.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Elizabeth Larios	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SHERWOOD STATE / MIGRANT PRESCHOOL CHILD CARE	FACILITY NUMBER: 270710406
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/14/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/14/2021 Section Cited	1 2 3 4 5 6 7	Care and Supervision No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).
	8 9 10 11 12 13 14	This was not met by: On 8/30/2021 child (C-1) walked out onto the side walk located in the school parking lot near the fence of the school. Child (C-1) was left without direct supervision for a short period of time and found by parent. This presents a potential risk to the health/safety of children in care.	8 9 10 11 12 13 14	AB633 Parent Notification is required. This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements. Copy of the signed acknowledgment form must be kept in each child's file.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Elizabeth Larios	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021

LIC809 (FAS) - (06/04)

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