430700665-6-7-2022-07-CC-PHEZ-CF6RRQ-20220607131530

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430700665
Report Date: 06/07/2022
Date Signed: 06/07/2022 01:15:50 PM

Document Has Been Signed on 06/07/2022 01:15 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:	VILLAGE PRESCHOOL		FACILITY NUMBER:	430700665
ADMINISTRATOR:	LINDA KERIN GARVEY		FACILITY TYPE:	850
ADDRESS:	20390 PARK PLACE		TELEPHONE:	(408) 867-3181
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	65	CENSUS: 0	DATE:	06/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jackie Allen		TIME COMPLETED:	01:22 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), Pete Hernandez, met with Site Director, Jackie Allen, for a Required 1 Year inspection. LPA was at location between child care sessions so there were no teachers or children to observe at this time. 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 (PUB 269), and Activity Schedule. There is an active waiver to allow licensor even though outdoor space is only measured for 50 children. LPA reviewed 10 children's files and 9 staff files. One teacher showed proof of valid CPR/First Aid that expires 6/30/23. Site Director 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: should they resume. LPA reviewed the sign in/out sheets. LPA observed that the teacher/child ratio was in compliance during today's inspection of records. Site Director understands the conditions, limitations, and capacity specifications of the Facility license. Site Director understands that the children shall be visually supervised at all times and never left unattended. The rooms are clean. Site Director states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the early morning and after school. Drinking water is readily available for the children indoor via water bottles and disposable cups and in the outdoor areas via drinking fountains. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which a sick child can use if needed. Site Director states that there are no weapons or firearms on the premises. Cleaning supplies are stored in the upper cabinet in each room inaccessible to children. There are trash cans with tight lids throughout the facility for the disposal of solid waste. LPA observed a functioning fire extinguishers, carbon monoxide detector, and fire pull stations at the facility. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06/07/2022):

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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: VILLAGE PRESCHOOL	FACILITY NUMBER: 430700665
	VISIT DATE: 06/07/2022

NARRATIVE

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Facility has age appropriate furniture and equipment, mats. No baby walkers or bouncers were witnessed during the inspection. All storage containers for solid waste had tight fitting covers and were in good repair. Facility was free of flies, other insects, and rodents. Facility has adequate indoor activity space for children that is physically separate from space used by the preschool child care center. Bottles, dishes, and containers of food brought by the child's authorized representative are labeled with the child's name and current date. Facility has adequate outdoor activity space and play equipment that is maintained in a safe condition and is free of hazards.

The outdoor activity area is surrounded by appropriate fencing. The play structure and equipment outside were age appropriate in good condition. Areas around play structure were cushioned with resilient materials. Shaded rest areas are provided by canopy. LPA did not observe any bodies of water.

All Staff were fingerprinted and associated to the facility. LPA reminded Director 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. For an initial violation, civil penalty amounts to $100.00 per person per day with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person. LPA also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.
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Page #3 of Report dated 6/7/2022

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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: VILLAGE PRESCHOOL	FACILITY NUMBER: 430700665
	VISIT DATE: 06/07/2022

NARRATIVE

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Director has a with current certification in Pediatric CPR and First Aid present at the facility during inspection. Licensee / Directors expires on 6/30/2023. Children's Roster was reviewed, and a copy obtained.

LPA Hernandez reviewed the files of 9 Teachers and 10 children. All or the required documentation was available in the file.

This facility does not provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

TYPE A language: SHOULD THERE EVER BE AN ISSUANCE of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with the Licensee. A copy of this report was discussed and left with the Licensee, Jacqueline Allen, whose signature on this form confirm receipt of these documents.

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

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC809 (FAS) - (06/04)

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