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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274407552
Report Date: 12/13/2022
Date Signed: 12/13/2022 01:28:19 PM


Document Has Been Signed on 12/13/2022 01:28 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:CREEKSIDE PRESCHOOLFACILITY NUMBER:
274407552
ADMINISTRATOR:MONICA CANO-RAYASFACILITY TYPE:
850
ADDRESS:1770 KITTERY STREETTELEPHONE:
(831) 753-5252
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:24CENSUS: 20DATE:
12/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Mayra Ramirez & Rosa Renteria TIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Larios conducted a unannounced Required-1 year inspection. LPA met with Lead Teacher Mayra Ramirez and explained the nature of today's visit. Lead Teacher Mayra called Alisal Union School District to inform staff of inspection and brining children files for review. LPA toured the facility both inside and outside during todays visit. LPA noted that the facility is located on the Creekside Elementary School campus, in classrooms 29A. The hours of operation are Monday - Friday, 8:15am - 3:30pm. The preschool operates two inclusions (8:15am-11:15am and 12:30pm-3:30pm).The program is run by the Alisal Union School District. 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.

LPA reviewed five 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 Lead Teacher file contain the required transcripts/verification of experience. All staff at this facility are fingerprinted through Department of Education/ Alisal Union 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. Drinking water is readily available for the children in classroom and in the outdoor playground area via water bottle & dispenser/cups. LPA observed solid waste containers with tight-fitting lids in classroom. Children's bathrooms are clean, and sanitary. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Lead Teacher states that there are no weapons or firearms on the premises. CONTINUE ON LIC 809-C

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
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: CREEKSIDE PRESCHOOL
FACILITY NUMBER: 274407552
VISIT DATE: 12/13/2022
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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. Facility share their playground with Creekside Head start # 274406730. Lead Teacher stated that they follow a set schedule.

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 extinguisher, and did not have a working smoke/carbon monoxide detector. Lead Teacher states that the facility does not administer medications at this time.

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

Deficiencies cited, exit interview conducted with Lead Teacher Mayra Ramirez 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 SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
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)
Page: 2 of 3
Document Has Been Signed on 12/13/2022 01:28 PM - It Cannot Be Edited

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: CREEKSIDE PRESCHOOL
FACILITY NUMBER: 274407552

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.
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

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 observed the exit ramp in the right side damaged needs to be replaced or repaired due to flooring being rusty, uneven/tripping hazard, and sharp 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 need to replace or repair exit ramp in right side and submit proof to Licensing by POC date. Creekside Elementary School maintenance staff placed an order to repair the ramp.
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 SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
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)
Page: 3 of 3