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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415311
Report Date: 10/13/2021
Date Signed: 10/13/2021 04:15:58 PM

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:HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOLFACILITY NUMBER:
274415311
ADMINISTRATOR:MICHELLE SKOGENFACILITY TYPE:
850
ADDRESS:345 EAST ALVIN DRIVETELEPHONE:
(831) 449-7536
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:100CENSUS: 60DATE:
10/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:06 PM
MET WITH:Rosebelle BalbalanTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Joe Macias conducted an unannounced Required - 1 Year Inspection (care tool). The purpose of today’s visit is to ensure the facility is in compliance with Title 22 California Code of Regulations. LPA met with the Acting Site Supervisor Rosebelle Balbalan, and explained the nature of today's visit. LPA toured the Facility both inside and outside during todays 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), and Activity Schedule. The hours of operation are Monday - Friday, 6:30am - 6:30pm.

LPA reviewed ten children's and ten 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. All staff files contain the required transcripts/verification of experience. All staff's CPR and First Aid certifications are current. The Director 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).

Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. LPA observed that all rooms are in order. Drinking water is readily available for the children in each room and in the outdoor playground area via water dispensers, pitchers, and cups. 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. Director states that there are no weapons or firearms on the premises.

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. LPA observed that the outdoor equipment is age appropriate. LPA did not observe any bodies of water.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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: HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOL
FACILITY NUMBER: 274415311
VISIT DATE: 10/13/2021
NARRATIVE
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The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. While touring the facility the LPA observed cleaning supplies accessible to the children underneath the small sink where children wash their hands. The cabinets were unlocked, and the toxins (Clorox hydrogen peroxide wipes, and microban) were present. LPA Macias explained that all cleaning supplies must be securely stored and inaccessible to the children. LPA observed a fully charged 2A10BC fire extinguisher, and working smoke/carbon monoxide detectors. Director states that the Facility does not administer any medications at this time. (no daily medication)

Acting Site Supervisor was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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



To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Type A deficiency cited, exit interview conducted and report was reviewed with the Site Supervisor Rosebelle Balbalan.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOL
FACILITY NUMBER: 274415311
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Deficient Practice Statement
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Buildings and Grounds 101238(g)/ Type A
While touring the facility the LPA observed cleaning supplies accessible to the children underneath the small sink where children wash their hands. The cabinets were unlocked, and the toxins (Clorox hydrogen peroxide wipes, and microban) were present. LPA Macias explained that all cleaning supplies must be securely stored and inaccessible to the children.
POC Due Date: 10/22/2021
Plan of Correction
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The Site Supervisor shall conduct a staff training on the importance of the correct storage of cleaning supplies/ toxins. The Site Supervisor will submit proof of training along with staff sign in sheet for the training.
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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: HEARTS AND HANDS CHRISTIAN CHILDCARE & PRESCHOOL
FACILITY NUMBER: 274415311
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2021
Plan of Correction
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The Site Supervisor shall conduct a staff training on the importance of the correct storage of cleaning supplies/ toxins. The Site Supervisor will submit proof of training along with staff sign in sheet for the training.
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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4