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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274404902
Report Date: 11/30/2023
Date Signed: 11/30/2023 12:57:00 PM

Document Has Been Signed on 11/30/2023 12:57 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CESAR E. CHAVEZ PRESCHOOLFACILITY NUMBER:
274404902
ADMINISTRATOR:GABRIEL RAMIREZFACILITY TYPE:
850
ADDRESS:1225 TOWT STREETTELEPHONE:
(831) 753-5589
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 13DATE:
11/30/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Maria Carmen AvalosTIME COMPLETED:
12:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Larios conducted an unannounced Case Management - Annual Continuation inspection. LPA met with the Site Teacher, Maria Carmen Avalos and explained the nature of today's visit. LPA noted that the facility is located on the Cesar E. Chavez Elementary School campus, in classroom 35. 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 preschool has two sessions 8:15am-11:15am and 12:30pm-3:30pm. The hours of operation are Monday - Friday, 8:00am - 5:00pm.

LPA reviewed three children's and three 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 Site Teacher file contain the required transcripts/verification of experience. All staff have clearances through Monterey County Office of Education. Site Teacher had current CPR and First Aid certifications on file. All staff have Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record and required Training. All staff have completed the Mandated Reporter Training. Site 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. LPA was unable to review staff (S3) file not available.

Site Teacher understands the conditions, limitations, and capacity specifications of the facility license. Site Teacher understands that children shall be visually supervised at all times. LPA observed that all rooms are clean and in order. Drinking water is readily available for the children in classroom and in the outdoor playground area via water bottles. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Site Teacher states that there are no weapons or firearms on the premises. CONTINUE ON LIC 809-C

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: CESAR E. CHAVEZ PRESCHOOL
FACILITY NUMBER: 274404902
VISIT DATE: 11/30/2023
NARRATIVE
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LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate. LPA did not observe any bodies of water.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food is prepared at the centralized kitchen. Cleaning supplies are securely stored and inaccessible to the children. LPA observed a fully charged 3A40BC fire extinguisher, and working smoke (fire pull station/carbon monoxide detector. Site Teacher states that the Facility does administer medications at this time.

This facility does not provide Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 Site Teacher Maria Carmen Avalos, 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.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 11/30/2023 12:57 PM - It Cannot Be Edited


Created By: Elizabeth Larios On 11/30/2023 at 12:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CESAR E. CHAVEZ PRESCHOOL
FACILITY NUMBER: 274404902

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above as the facility has not completed water lead testing or submitted water lead test results that follow the written directives, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/01/2023
Plan of Correction
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Licensee will complete Water Lead Testing and send proof of completion to LPA by Plan of Correction date of 12/01/2023. LPA provided Licensee with a copy of PIN 21-21. 1-CCP.
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:Joel Segura
LICENSING EVALUATOR NAME:Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/30/2023 12:57 PM - It Cannot Be Edited


Created By: Elizabeth Larios On 11/30/2023 at 12:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CESAR E. CHAVEZ PRESCHOOL
FACILITY NUMBER: 274404902

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101217(d)
Personnel Records
(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Staff (S3) file was not available for review which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/05/2023
Plan of Correction
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Licensee will send a completed file for staff (S3) to LPA by Plan of Correction date of 12/05/2023.
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:Joel Segura
LICENSING EVALUATOR NAME:Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023


LIC809 (FAS) - (06/04)
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