270710410-10-6-2022-07-CC-ELAS-CJVRBS-20221004125312

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 270710410
Report Date: 10/04/2022
Date Signed: 10/06/2022 08:43:39 AM

Document Has Been Signed on 10/06/2022 08:43 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	NO. MONTEREY CO. UNIFIED SCH. DIST. PRESCHOOL		FACILITY NUMBER:	270710410
ADMINISTRATOR:	MARGARITA PALACIOS		FACILITY TYPE:	850
ADDRESS:	17719 PESANTE ROAD		TELEPHONE:	(831) 663-6129
CITY:	PRUNEDALE	STATE: CA	ZIP CODE:	93907
CAPACITY:	44	CENSUS: 14	DATE:	10/04/2022
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Kristina Torres		TIME COMPLETED:	01:00 PM

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Licensing Program Analyst (LPA) Elizabeth Larios conducted a unannounced annual continuation inspection. LPA met with Teacher Tanvi Shah and explained the nature of today's visit. Teacher Tanvi called Kristina Torres Preschool Program Coordinator to inform her of inspection.

LPA reviewed children's and staff files during today's visit. Each child's file reviewed contains the Information and Emergency Information form (LIC 700), immunization records, physicians report, personal rights, and parents rights. The Lead Teacher file contain the required transcripts/verification of experience. All staff have clearances through North Monterey County Unified School District. Lead Teacher has current CPR and First Aid certifications on file. Staff have Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record and required Training. Staff had current Mandated Reporter Training certificate in file. Lead Teacher understands that there shall be at least one person with valid CPR and First Aid certifications on site at all times, or present during off-site activities.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. Cleaning supplies are securely stored and inaccessible to the children. LPA observed a fully charged 3A40BC fire extinguishers, and working smoke/carbon monoxide detectors and First Aid Kits. Lead Teacher states that the facility does not administer medications at this time.

====CONTINUE ON LIC 809-C====

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth Larios	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

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

FACILITY NAME: NO. MONTEREY CO. UNIFIED SCH. DIST. PRESCHOOL	FACILITY NUMBER: 270710410
	VISIT DATE: 10/04/2022

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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

No deficiencies cited, exit interview conducted with Kristina Torres Preschool Program Coordinator and a copy of this report was provided.

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

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth Larios	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022

LIC809 (FAS) - (06/04)

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