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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354407554
Report Date: 03/03/2020
Date Signed: 03/03/2020 12:28:51 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:SPRING GROVE PRE-K AND PRESCHOOLFACILITY NUMBER:
354407554
ADMINISTRATOR:JENNIFER BERNOSKYFACILITY TYPE:
850
ADDRESS:500 SPRING GROVE ROADTELEPHONE:
(831) 637-5574
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:20CENSUS: DATE:
03/03/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Gail DelucchiTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA), Deanna Villagrana, conducted an unannounced 1 year required visit to the Facility today. LPA met with Gail Delucchi, head teacher, and explained the nature of today's visit to her. The Facility is licensed in room 25 on Spring Grove Elementary school. The playground area of the Facility is located to the left of the classroom. LPA later met with Jenny Bernosky, Director and Erin Livingston, HR analyst to continue report. The Facility has two active waivers to share playground with kindergarten children and to commingle preschool children and K-8 students during special events.

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. Staff are cleared through North County Joint Union School District..

LPA reviewed ten children's and two staff (1 teacher and 1 aide) files during today's inspection. Children's files were complete. All five staff have current CPR and First Aid certifications on file. Teacher's file reviewed contains the required transcripts/verification of experience. Jenny 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 20 preschool children with two teachers in room 25. Jenny understands the conditions, limitations, and capacity specifications of the Facility license. Jenny understands that children shall be visually supervised at all times. LPA observed that the room is clean and safe for all children and staff. Jenny states that the Facility is cleaned by janitorial services provided by the school. Drinking water is readily available for the children in each room and in the outdoor playground area via water fountain. Children's bathrooms are clean, sanitary, and operable. There is a separate staff toilet not utilized by the children. Jenny states that there are no weapons or firearms on the premises.

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

DATE: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SPRING GROVE PRE-K AND PRESCHOOL
FACILITY NUMBER: 354407554
VISIT DATE: 03/03/2020
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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 locked cabinets inaccessible to children. Any poisons are stored in locked storage cabinets. Any medications at the Facility would be stored in a locked box stored inaccessible to children. 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. A large tree provides shade for the day care children. LPA did not observe any bodies of water.

LPA conducted an exit interview with the Jenny prior to the conclusion of today's visit and referred Jenny to the Department website: www.cdss.ca.gov for additional information regarding Licensing Forms and Title 22 Regulations.

No deficiencies were cited during visit.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FACILITY ENTRANCE, 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: 03/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020
LIC809 (FAS) - (06/04)
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