334811701-8-6-2020-10-CC-SBRR-BS8VEA-20200806162202

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334811701
Report Date: 08/06/2020
Date Signed: 08/06/2020 04:22:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME:	SJUSD-HYATT HEAD START STATE PRESCHOOL		FACILITY NUMBER:	334811701
ADMINISTRATOR:	ZARAGOZA, ELIZABETH		FACILITY TYPE:	850
ADDRESS:	400 E. SHAVER		TELEPHONE:	(951) 487-0526
CITY:	SAN JACINTO	STATE: CA	ZIP CODE:	92583
CAPACITY:	82	CENSUS: 0	DATE:	08/06/2020
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Licensee Program Director Elizabeth Zaragoza		TIME COMPLETED:	04:30 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	On 08/06/2020 at 2:30 PM, Licensing Program Analysts (LPAs), Susan Brewer and Ana Noble, arrived at the facility at the request of the Licensee Program Director (PD) Elizabeth Zarragoza, for the purpose of conducting a Case Management Visit for Increase of Capacity. LPAs were greeted by the Licensee Director and granted entry to tour Preschool center, inside and out. The days and hours of operation will be: State Pre-School Part-Day, Double Session: Morning Session 7:50 AM to 10:50 AM and Afternoon Session 11:35 AM to 2:35 PM. The following measurements were taken: Preschool Indoor Activity Areas LPA has determined that there is sufficient space to accommodate 96 children in Classrooms 1 and 2, through the rotation of Part-Day Pre-School sessions split by morning and afternoon classes. Classroom #2 Total: 2,475.39 sq ft / 35 sq ft (per child) = 71 children Length 39'04" x Width 28'08" = 2,538.32 sq ft Encumbered Spaces: #1 Built-In wall cabinet: Length 7'2" x Width 1'7" = (- 7.5) #2 Built-In wall cabinet: Length 8'6" x Width 2'7" = (-16.68) Tall Storage Cabinet: Length 3' x Width 1'6" = (-3.18) Restroom: Length 7'10" x Width 3'6" = (-25.56)

SUPERVISOR'S NAME: Telma Sandoval	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2020

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SJUSD-HYATT HEAD START STATE PRESCHOOL	FACILITY NUMBER: 334811701
	VISIT DATE: 08/06/2020

NARRATIVE

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Preschool Bathroom Fixtures
2 toilets x 15 = 30 children
4 sinks x 15 = 60 children

Preschool Outdoor Activity Area:
LPA has determined that there is adequate space to accommodate 96 children.

Limiting factor for preschool capacity is 96, subject to verification of waiver for use of elementary school restrooms or the licensee will submit a written request for a waiver for preschool children to use the elementary school restrooms. Preschool capacity is limited to 96 children, per licensee request.

The following was observed:
· Classrooms are adequately equipped with age and size appropriate furniture and equipment
· Drinking fountains and igloos with disposable dixie cups will supply drinking water in the indoor activity space.
· Playgrounds are enclosed by appropriate fences verified on 08/06/2020
· Outdoor activity areas are supplied with age and size appropriate equipment
· There are no accessible bodies of water present on 08/06/2020. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· An adequate amount of cushioning material grass and soft surface rubber matting, is in place under play equipment
· Adequate shade is provided.
· Drinking water is provided in the outdoor play areas by fountain and igloo dispensers with disposable dixie cups. LPA Ana Noble observed outside the 1st drinking fountain to be broken and the 2nd drinking fountain to be non-operable.

SUPERVISOR'S NAME: Telma Sandoval	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2020

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SJUSD-HYATT HEAD START STATE PRESCHOOL	FACILITY NUMBER: 334811701
	VISIT DATE: 08/06/2020

NARRATIVE

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· Fooda is prepared and delivered by the school cafeteria staff. Menus not posted due to summer break, school not in session at the time of inspection on 08/06/2020.
· The office area is located at the north/west end of the classroom and will serve as the isolation area for ill children temporarily until parents arrive.
· Staff bathroom will also be used as the isolation bathroom and is conveniently located to the isolation area.
· Toxins are locked
· Medication will be stored in a medical bag and secured in a locked tall storage cabinets.
· The Licensee states that they are providing Incidental Medical Services at this time. LPA informed the Licensee that prior to providing any incidental medical services that a written plan must be submitted to the licensing office.
· Medication administration forms were reviewed and on file.
· First Aid kit is complete on 08/06/2020
· Waiver on for electronic Sign in/Sign out records and a hard copies will be used for emergency back up to meet regulation requirements.
· The Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
· A review of staff records on 08/06/2020 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at Associations_Disassociations858@dss.ca.gov
· The applicant has been informed that all employees must be associated to the facility. If the licensee fails to have proof of a fingerprint clearance or fails to associate a previously cleared individual to the facility, a civil penalty of $100.00, per day the person has been present, will be assessed.

SUPERVISOR'S NAME: Telma Sandoval	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2020

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SJUSD-HYATT HEAD START STATE PRESCHOOL	FACILITY NUMBER: 334811701
	VISIT DATE: 08/06/2020

NARRATIVE

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The first violation is subject to the penalty for up to five days. If there is a subsequent violation in a 12-month period, the fine will continue for up to 30 days.
· The applicant was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must be posted for 30 days.

The following was also reviewed and discussed:
· Facility is providing IMS 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.

· For more information on SIDS and Safe Sleep Environments, please visit:
California Department of Public Health – California SIDS Program: http://www.cdph.ca.gov/programs/SIDS/pages/default.aspx
AAP – Safe Sleep Campaign: http://www.healthychildcare.org/sids/html
AAP-Free Training: Reducing the Risk of SIDS in Early Education and Child Care: http://shop.aap.org/Reducing-the-Risk-of-SIDS-in-Early-Education-and-Child-Care
And Caring for our Children, Safe Sleep Practices and SIDS/Suffocation Risk Reduction: http://cfoc/nrckids/org/standardview/spccol/safe_sleep

v Access to forms & Regulations for a Child Care Center are online at www.ccld.ca.gov.

SUPERVISOR'S NAME: Telma Sandoval	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2020

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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: SJUSD-HYATT HEAD START STATE PRESCHOOL	FACILITY NUMBER: 334811701
	VISIT DATE: 08/06/2020

NARRATIVE

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v Please subscribe at www.childcareadvocatesprogram to receive Department updates. They will be sent directly to your e-mail account once you have set up an account. This website can also be accessed through www.ccld.ca.gov
v The Duty Officer is available to answer questions Monday – Friday at 1-844-LET-US-NO (1-844-538-8766).

An exit interview was conducted by LPAs Susan Brewer and Ana Noble and during the interview, the licensee Director Elizabeth Zaragoza, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

The following items need to be completed/corrected prior to a license being issued:
1. Outside drinking fountain will need to be replaced.
2. Waiver to use elementary school restrooms.
3. Mandated Postings to include the facility license, LIC610 Emergency Plan and LIC9148 Earthquake Preparedness Plan, LIC999 Facility Sketch and the PUB394 Parent Rights Poster.

Once all corrections have been made, with proof sent to licensing, and the fire clearance has been obtained, the application will be submitted for approval with a maximum capacity of 96. As agreed upon by the applicant, all corrections are due within 30 days. If not received within 30 days from the date of this report, the application will be denied. An exit interview was conducted and a copy of this report was provided to the applicant on this date.

A copy of this report must be made available to the public for 3 years.

SUPERVISOR'S NAME: Telma Sandoval	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Susan Brewer	TELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2020

LIC809 (FAS) - (06/04)

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