354412143-8-9-2021-07-CC-DVIA-C5QUBT-20210809152653

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 354412143
Report Date: 08/09/2021
Date Signed: 08/09/2021 03:27:00 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:	GO KIDS CLUB @ RO HARDIN		FACILITY NUMBER:	354412143
ADMINISTRATOR:	MITSY NAVARRO		FACILITY TYPE:	850
ADDRESS:	761 SOUTH STREET		TELEPHONE:	(831) 636-8171
CITY:	HOLLISTER	STATE: CA	ZIP CODE:	95023
CAPACITY:	32	CENSUS: 0	DATE:	08/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:16 PM
MET WITH:	Mitsy Navarro		TIME COMPLETED:	03:36 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 an unannounced required 1 year visit to the Facility today. LPA met with Mitsy Navarro, director, and explained the nature of today's visit to her. The Facility is licensed in the last room to the right of the building. The playground area of the Facility is located in the backside of the building. LPA noted the facility also has a school age program (#350710320) on site. 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 08/04/2021 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 Mitsy 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 eight children's and one teacher's file during today's inspection. Children and staff files are complete. Teacher has a current CPR and First Aid certifications on file. Teacher's files reviewed contain the required transcripts/verification of experience and immunizations. Mitsy 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: 08/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021

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: GO KIDS CLUB @ RO HARDIN	FACILITY NUMBER: 354412143
	VISIT DATE: 08/09/2021

NARRATIVE

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Mitsy stated children left for the day. Today eight children were present with teacher Linda Torres. LPA observed sign in/out sheet. There are only eight children enrolled at this time. Mitsy understands the conditions, limitations, and capacity specifications of the Facility license. Mitsy understands that children shall be visually supervised at all times. LPA observed room is clean and safe for all children and staff. Mitsy state the Facility is cleaned by and outside janitorial service. Drinking water is readily available for the children in the room and in the outdoor playground area via water container and 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 which an isolated child can use if needed. Mitsy 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 inaccessible to children. Any poisons are stored in high 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 gazebo and building overhang provides shade for the day care children. LPA did not observe any bodies of water.

Licensing Forms, Title 22 Regulations, and information can be obtained through the internet at www.cdss.ca.gov.

No deficiencies were cited.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FACILITY ENTRANCE, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021

LIC809 (FAS) - (06/04)

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