354412143-12-8-2022-07-CC-DVIA-CLWT9P-20221208133216

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 354412143
Report Date: 12/08/2022
Date Signed: 12/08/2022 01:32:20 PM

Document Has Been Signed on 12/08/2022 01:32 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:	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: 5	DATE:	12/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Mitsy Navarro		TIME COMPLETED:	01:35 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 one year inspection to the Facility today. LPA met with director, Mitsy Navarro and explained the nature of today's visit to her. The Facility is licensed in portable room 1 and is a half day program. LPA notes that the facility has a license for school age program (350710320) at the Facility. The playground area of the Facility is located behind the portables. 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 12/05/2022 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions Director Mitsy Navarro was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated. 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 five staff have current CPR and First Aid and Mandated Reporter training certificates on file. All staff have immunization records on file. All five staff files reviewed contain the required transcripts/verification of experience. 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: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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: GO KIDS CLUB @ RO HARDIN	FACILITY NUMBER: 354412143
	VISIT DATE: 12/08/2022

NARRATIVE

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LPA observed that the teacher/child ratio was in compliance during today's visit. LPA observed five preschool children with one teacher in the classroom. 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 that room is clean and safe for all children and staff. Mitsy states that the Facility staff has a janitorial service that come in the evenings to clean the Facility. Drinking water is readily available for the children in each 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 locked storage cabinets. Any medications at the Facility are stored in a medicine box an hung by the door going into classroom two. There is also a locked box for refrigerated medicine if needed. 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 (sand and tan bark) are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. A gazebo and the building overhang provide shade for the day care children. LPA did not observe any bodies of water.

Exit interview conducted and report was reviewed with the Director Mitsy Navarro.

No deficiencies were cited.

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: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC809 (FAS) - (06/04)

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