354407554-9-1-2022-07-CC-DVIA-CHUSS9-20220901140735

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 354407554
Report Date: 09/01/2022
Date Signed: 09/01/2022 02:07:44 PM

Document Has Been Signed on 09/01/2022 02:07 PM - It Cannot Be Edited

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 PRESCHOOL		FACILITY NUMBER:	354407554
ADMINISTRATOR:	JENNIFER BERNOSKY		FACILITY TYPE:	850
ADDRESS:	500 SPRING GROVE ROAD		TELEPHONE:	(831) 637-5574
CITY:	HOLLISTER	STATE: CA	ZIP CODE:	95023
CAPACITY:	20	CENSUS: 10	DATE:	09/01/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Jennifer Bernosky		TIME COMPLETED:	02:20 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 Analyst (LPA), Deanna Villagrana, conducted a 1 year required visit to the Facility today. LPA met with Leeann Gaitan, 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 Jennifer Bernosky, Director and Erin Livingston, HR analyst to continue report. The Facility has two active waivers to share playground with kindergarten children and to comingle 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 one staff (1 teacher) files during today's inspection. LPA observed Director Jennifer Bernosky is employed by North County Joint Union School District as Superintendent/Principal. Teacher and children's files were complete. Two staff have current CPR and First Aid certifications on file. Teacher's file reviewed contained the required transcripts/verification of experience. Jennifer 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).

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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: 09/01/2022

NARRATIVE

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LPA observed that the teacher/child ratio was in compliance during today's visit. LPA observed 10 preschool children with one teacher. Jennifer understands the conditions, limitations, and capacity specifications of the Facility. Jennifer understands that children shall be visually supervised at all times. LPA observed that the room is clean and safe for all children and staff. Spring Grove School janitorial is in charge of cleaning the facility. Drinking water is readily available for the children in each room and in the outdoor playground area via water fountain. 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 which an isolated child can use if needed. Jennifer states that there are no weapons or firearms on the premises. Spring Grove School has an on duty Sheriff is on campus daily and carries a firearm.

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 out of reach. Any poisons are stored in locked storage cabinets. Any medications at the Facility are stored in the director's office area. 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 tree and umbrella provide shade for the day care children. LPA did not observe any bodies of water.

Exit interview conducted and report was reviewed with the licensee Jennifer Bernosky.

The following type B deficiency was cited on the attached page (809-D). Licensee was informed that failure to correct the deficiency by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/01/2022 02:07 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101215.1(d)(1)

This requirement is not met as evidenced by: The Child Care Center Director shall not accept outside employment that interferes with the duties specified in this chapter.
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above. Director Jennifer Bernosky is employed by North County Joint Union School District as Superintendent/Principal which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/15/2022
	Plan of Correction
1 2 3 4	Jennifer Bernosky will enroll teacher Leann Gaitan into and admin class to qualify as the Director of the facility and notify CCLD by POC date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC809 (FAS) - (06/04)

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