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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274404970
Report Date: 12/13/2022
Date Signed: 12/13/2022 04:00:31 PM

Document Has Been Signed on 12/13/2022 04:00 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:HENRY F. KAMMANN ELEMENTARY SCHOOLFACILITY NUMBER:
274404970
ADMINISTRATOR:JENNIFER ZANZOTFACILITY TYPE:
850
ADDRESS:521 ROCHEX AVENUETELEPHONE:
(831) 753-5665
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 11DATE:
12/13/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Cecilia Mora & Maria Flores Cervantes TIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Larios conducted a unannounced annual continuation inspection. LPA met with Teacher Cecilia Mora and explained the nature of today's visit.

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 Salinas City Elementary 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.

Lead Teacher understands the conditions, limitations, and capacity specifications of the facility license. Lead Teacher understands that children shall be visually supervised at all times. LPA observed classroom clean and in order. Lead Teacher states that there are no weapons or firearms on the premises.

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

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

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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: HENRY F. KAMMANN ELEMENTARY SCHOOL
FACILITY NUMBER: 274404970
VISIT DATE: 12/13/2022
NARRATIVE
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Deficiency cited, exit interview conducted with Lead Teacher Maria Flores Cervantes 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: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/13/2022 04:00 PM - It Cannot Be Edited


Created By: Elizabeth Larios On 12/13/2022 at 03:52 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: HENRY F. KAMMANN ELEMENTARY SCHOOL
FACILITY NUMBER: 274404970

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA did not observe a working carbon monoxide detector which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/20/2022
Plan of Correction
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Licensee will purchase and install a carbon monoxide detector submit proof to Licensing by POC date. Corrected during inspection.
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: 12/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022


LIC809 (FAS) - (06/04)
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