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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354413128
Report Date: 08/26/2021
Date Signed: 08/26/2021 12:59:08 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:ASJUSD/SAN JUAN MI ESCUELITA PRESCHOOLFACILITY NUMBER:
354413128
ADMINISTRATOR:FABIOLA VALADEZFACILITY TYPE:
850
ADDRESS:100 NYLAND DRIVETELEPHONE:
(831) 623-4538
CITY:SAN JUAN BAUTISTASTATE: CAZIP CODE:
95045
CAPACITY:24CENSUS: 6DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Margarita Carrillo-GaitanTIME COMPLETED:
01:10 PM
NARRATIVE
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Licensing Program Analyst (LPA), Deanna Villagrana, conducted a one year required visit to the Facility today. LPA met with Margarita Carrillo-Gaitan, director, and explained the nature of today's visit to her. The Facility is licensed in a room located at San Juan Elementary School. The playground area of the Facility is located behind the classroom. LPA notes that the Facility has two waivers on file which allows them to share the bathroom and playground with the kindergarten class located next door to the preschool. LPA reminded Margarita that the preschool and kindergarten children cannot commingle, either inside the Facility or in the playground area of the Facility, outside the times of the approved waivers.

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.

All staff have clearances through Aromas-San Juan Unified School District. LPA reviewed six children's and three staff files (1 director & 2 teachers Krystal Meza and Carolina Orozco) files during today's inspection. All children's files were complete. Teacher Krystal Meza is missing immunization records. All three staff have current CPR and First Aid certifications on file. All three staff files reviewed contain the required transcripts/verification of experience. Margarita 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 six preschool children with two teachers in the playground. Margarita understands the conditions, limitations, and capacity specifications of the Facility license. Margarita understands that children shall be visually supervised at all times. During the visit, child 1 entered the classroom were LPA was typing report. According to teacher Krystal, she was in the playground and Carolina had went to the bathroom. Margarita was in her office with the door closed. Krystal stated she was aware child went into the classroom but she was tending to another child and then she came to the door to tell the child to stay outside. Child was unsupervised for approximately two minutes. LPA observed the room is clean and safe for all children and staff. Margarita states that the
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
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 4
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: ASJUSD/SAN JUAN MI ESCUELITA PRESCHOOL
FACILITY NUMBER: 354413128
VISIT DATE: 08/26/2021
NARRATIVE
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Facility is cleaned by janitorial service provided by the school. Children bring their own water jugs with drinking water. Facility is able to refill if necessary. LPA observed solid waste containers with tight-fitting lids in the Facility. Children's bathroom is clean, sanitary, and operable. There is a separate staff toilet not utilized by the children in the office. Margarita 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. All meals are provided by the San Juan Elementary cafeteria. 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 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 canopy and the building overhang provide shade for the day care children. LPA did not observe any bodies of water.

LPA was made aware when arriving to the facility, a child tested positive on 08/13/2021. LPA asked if Margarita notified CCLD. Margarita stated she did not notify CCLD regarding child testing positive for COVID-19.

LPA discussed Zero Tolerance related regulations with director Margarita Carrillo-Gaitan and was advised of the assessment of $500 immediate civil penalty and an ongoing $100 per day per violation continues until the violation(s) is corrected. LPA discussed the requirements of AB633 to director Margarita and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Margarita understands the requirements. Upon receipt, director Margarita shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.


The following type A and B deficiencies were cited on the attached page (809-D). Margarita was informed that failure to correct the deficiencies 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 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: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: ASJUSD/SAN JUAN MI ESCUELITA PRESCHOOL
FACILITY NUMBER: 354413128
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2021
Section Cited

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Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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This requirement was not met as evidenced by Margarita stated she did not notify CCLD regarding child testing positive for COVID-19. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
09/27/2021
Section Cited

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1597.622 (a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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This requirement was not met as evidenced by Teacher Krystal Meza is missing immunization records. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: ASJUSD/SAN JUAN MI ESCUELITA PRESCHOOL
FACILITY NUMBER: 354413128
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/27/2021
Section Cited

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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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This requirement was not met as evidenced by Child was unsupervised for approximately two minutes. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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AB633 Parent Notification is required.
This page shall be provided to all parents of children currently enrolled and any future children being enrolled for the next 12 months per AB633 requirements.

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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 SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4