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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 350700523
Report Date: 02/11/2020
Date Signed: 02/11/2020 11:11:24 AM

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:PRESBYTERIAN CO-OPERATIVE PRESCHOOLFACILITY NUMBER:
350700523
ADMINISTRATOR:WENDY SUE CLARK SHEPHERDFACILITY TYPE:
850
ADDRESS:2066 SAN BENITO STREETTELEPHONE:
(831) 630-1234
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:60CENSUS: 27DATE:
02/11/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Heather LustTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA), Deanna Villagrana, conducted an unannounced annual/random inspection to the Facility today. LPA met with Heather Lust, Office Administrator, and explained the nature of today's visit to her. Director Wendy Shepherd was teaching in room 1. The Facility is licensed in room 1, 2, 3 and 4 of the Facility. The playground area of the Facility is located behind rooms 1 and 2.

LPA toured the Facility both inside and outside for today's inspection. 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, Menus, and Activity Schedule.

A review of staff records on 02/10/2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Heather of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.

LPA reviewed ten children's and three staff (1 director & 2 teachers) files during today's inspection. All staff and children's files were complete. All three staff have current CPR and First Aid certifications on file. All three staff files reviewed contain the required transcripts/verification of experience. Heather 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).

LPA observed that the teacher/child ratio was in compliance during today's visit. LPA observed 8 preschool children with one teacher and two parents in room 1, 11 preschool children with one teacher and two parents in room 2 and 8 preschool children with one teacher and 2 parents in

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
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 2
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: PRESBYTERIAN CO-OPERATIVE PRESCHOOL
FACILITY NUMBER: 350700523
VISIT DATE: 02/11/2020
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room 3. Room 4 is only used on Thursdays and Fridays. Heather understands the conditions, limitations, and capacity specifications of the Facility license. Heather understands that children shall be visually supervised at all times. LPA observed that all rooms are clean and safe for all children and staff. Heather states that parents rotate cleaning duties on a daily basis and have a deep cleaning days several times a year with all staff and parents who sign up to help at the Facility. Drinking water is brought by children in water containers and can be refilled by water dispenser in office or water spigot in playground. LPA observed solid waste containers with tight-fitting lids in the Facility. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff toilet not utilized by the children. Heather states that there are no weapons or firearms on the premises.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children and stored in the office. Any medications at the Facility are stored in the office locked away. No IMS is administered by the Facility at this time.

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. Several trees, canopies and covered patios provide shade for the day care children. LPA did not observe any bodies of water.

LPA conducted an exit interview with Heather prior to the conclusion of today's visit and referred Heather to the Department website: www.ccld.ca.gov for additional information on the online training. Licensing Forms, Title 22 Regulations, and information can be obtained through the internet at www.cdss.ca.gov. Appeal rights were provided to Sandra prior to the conclusion of today's visit.

No deficiencies were cited during visit.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2