274416184-8-28-2019-07-CC-JMAS-BFGSA9-20190828134155

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274416184
Report Date: 08/28/2019
Date Signed: 08/28/2019 01:42:00 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:	WELLSPRING PRESCHOOL/MAYFLOWER CHURCH OF PG,		FACILITY NUMBER:	274416184
ADMINISTRATOR:	JEANNIE TRABACK		FACILITY TYPE:	850
ADDRESS:	141 14TH STREET		TELEPHONE:	(831) 373-4705
CITY:	PACIFIC GROVE	STATE: CA	ZIP CODE:	93950
CAPACITY:	15	CENSUS: 0	DATE:	08/28/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Jeannie Traback		TIME COMPLETED:	01:50 PM

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	Licensing Program Analysts (LPA), Joe Macias conducted an announced Prelicensing Inspection. LPA met with the Applicant Jeannie Traback. The center is located at 141 14th Street, Pacific Grove, CA 93950, on the Wellspring Church grounds. The center will operate Monday through Friday from 9 AM to 11:30 AM. The Applicant has current CPR and first aid certification on file. A fire safety inspection approval was received from Monterey Fire Department prior to today's inspection. LPA toured the facility both inside and out. The following indoor measurements were taken today: PRESCHOOL ROOMS: ROOM 1: 30.4 x 36 = 1,094.4 TOTAL INDOOR SPACE = 1,094.4 sq.ft. divided 35 = 31.268 children The center will not be utilizing rooms two and three at this time. There are 2 sinks (30), and 1 toilet available for the children. Only cold water is available in the children's sinks. There is a separate staff bathroom located in room #3. The sick child will use the staff bathroom, the sick child will be isolated in the designated sick area (quiet area near the hall way), isolation equipment will be provided. First aid supplies are stored in the classroom, and are inaccessible to children. Cleaning supplies are securely stored and inaccessible to children. LPA observed fully charged 2A10BC fire extinguisher, and working smoke/carbon monoxide detectors. The center will only administer emergency medication and will be stored in a lock box in the classroom. The center will provide snacks for the children, no lunch will be served as this is a part time program. There is separate food preparation area, equipped with microwave, sink and refrigerator. There is a trash can with tight-fitting lid for the disposal of solid waste. There are a total of 20 chairs, 4 tables, and 16 cubbies. There are no mats/ cots present as the program will not have nap time due to the 11:30 AM dismissal time. There is adequate toys, equipment, and supplies for the children. Drinking water is provided indoor via water pitchers, and cups. Room temperature is controlled by central heating/air conditioning.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph Macias	TELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

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: WELLSPRING PRESCHOOL/MAYFLOWER CHURCH OF PG,	FACILITY NUMBER: 274416184
	VISIT DATE: 08/28/2019

NARRATIVE

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PRESCHOOL YARD:
Total Preschool Yard = 1,716.81
TOTAL OUTDOOR SPACE = 1,716.81 sq.ft. divided 75 = 22.890 children

The yard is surrounded by appropriate fencing. Shade is provided by trees. Drinking water will be provided by water pitcher and cups. No transportation is provided by the center. There is a working telephone in the office (831) 373-4705.

LPA Macias discussed the requirements of AB 633 to applicant representative and provided her the fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and applicant understands the requirements.

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

LPA conducted an exit interview with the Applicant, LPA advised the Applicant that the license will be granted pending Management approval.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph Macias	TELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2019

LIC809 (FAS) - (06/04)

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