274408917-8-26-2021-07-CC-SCES-C69PUJ-20210826113738

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274408917
Report Date: 08/26/2021
Date Signed: 08/26/2021 11:37:45 AM

Document Has Been Signed on 08/26/2021 11:37 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:	GABILAN STATE PRESCHOOL		FACILITY NUMBER:	274408917
ADMINISTRATOR:	ANGELA EHRLICH		FACILITY TYPE:	850
ADDRESS:	330 N. WALKER		TELEPHONE:	(831) 678-1581
CITY:	SOLEDAD	STATE: CA	ZIP CODE:	93960
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 0	CENSUS: 17	DATE:	08/26/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Laura Maldonado		TIME COMPLETED:	11:45 AM

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	On 08/26/2021 at 9:40 AM, Licensing Program Analyst (LPA), Susy Cervantes, conducted an unannounced annual visit to the Facility today. LPA met with Laura Maldonado, teacher, and explained the nature of today’s visit. LPA toured the Facility both inside and outside during today’s visit. 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), Menus, and Activity Schedule. All staff are employed by the Soledad Unified School District and are fingerprinted and cleared by their employer. LPA observed the medical assessment and the Information and Emergency Information form (LIC 700) in 5 children’s files. LPA observed the required health screening in 5 staff files. All 5 staff have current CPR and First Aid Certifications on file (expiration date: 09/22). 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 (field trips). Teacher understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. LPA reviewed the sign-in, sign-out sheets for the past 2 weeks, school started on 08/11/2021 and Child Care Facility Roster (LIC 9040) and all were in compliance. LPA observed that the teacher/child ratio was in compliance during today’s visit. LPA observed 5 teacher with 17 children in Room 6, only one room is used for the preschool program. LPA observed that all rooms are clean and safe for all children and staff. Drinking water is readily available for the children in each room and in the outdoor playground area via water bottles. *Continues on report dated 08/26/2021 pg. 1/2*

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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: GABILAN STATE PRESCHOOL	FACILITY NUMBER: 274408917
	VISIT DATE: 08/26/2021

NARRATIVE

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Continuation of report dated 08/26/2021 pg. 2/2

LPA observed solid waste containers with tight-fitting lids in each room and in the playground area. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Teacher states that there are no weapons on the premises.

Food is provided by the Gabilan Elementary School. Cleaning supplies are inaccessible to the children. Teacher stated there are no poisons at the facility. Any medications at the Facility are stored appropriately and in an off-limits area of the Facility, the elementary school office.

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 and in good condition. There is also sufficient resilient materials (type: pour and play rubber) in the outdoor playground area. LPA did not observe any bodies of water.

LPA discussed Zero Tolerance with $500 civil penalty and the requirements of AB633 with the teacher, Laura Maldonado, and provided them the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and she understands the requirements. Licensing Forms, Title 22 Regulations and Information can be obtained through the internet at www.cdss.ca.gov.

LPA conducted an exit interview with teacher prior to the conclusion of today’s visit. No deficiency cited.

NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

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