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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 350703360
Report Date: 02/11/2020
Date Signed: 02/11/2020 12:45:12 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:METHODIST PRESCHOOLFACILITY NUMBER:
350703360
ADMINISTRATOR:KELSO, BARBARAFACILITY TYPE:
850
ADDRESS:521 MONTEREY STREETTELEPHONE:
(408) 637-4240
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:24CENSUS: 22DATE:
02/11/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nicole CampbellTIME COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA), Deanna Villagrana, conducted an unannounced annual/random inspection to the Facility today. LPA met with Nicole Campbell, Head Teacher, and explained the nature of today's visit to her. The Facility is licensed in a building to the right of the church. The playground area of the Facility is located between the church and the building.

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 and Snack 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 Nicole 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 five staff (4 teachers and 1 Aide) files during today's inspection. All staff and children's files were complete. Four staff have current CPR and First Aid certifications on file. All four teachers reviewed contain the required transcripts/verification of experience. Nicole 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 14 preschool children with one teacher and one Aide in Circle room and 8 preschool children with two teachers in playground area. Nicole understands the conditions, limitations, and capacity

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: METHODIST PRESCHOOL
FACILITY NUMBER: 350703360
VISIT DATE: 02/11/2020
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specifications of the Facility license. Nicole understands that children shall be visually supervised at all times. LPA observed that rooms are clean and safe for all children and staff. Nicole states that the Facility staff rotate cleaning duties on a weekly basis and a janitorial services cleans facility on the weekends. Drinking water is readily available for the children in each room and in the outdoor playground area via pitchers/disposable cups. 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. Nicole 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 high cabinets or locked cabinets. No medications are kept at the Facility. No IMS is administered by the Facility.

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 and the building overhang provide shade for the day care children. LPA did not observe any bodies of water.

LPA conducted an exit interview with the Nicole prior to the conclusion of today's visit and referred Nicole 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.

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)
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