430702374-5-10-2023-07-CC-SYIP-CRPL4F-20230510082525

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430702374
Report Date: 05/09/2023
Date Signed: 05/10/2023 08:25:41 AM

Document Has Been Signed on 05/10/2023 08:25 AM - 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:	VINEYARD PRESCHOOL		FACILITY NUMBER:	430702374
ADMINISTRATOR:	JENNY MOSHER		FACILITY TYPE:	850
ADDRESS:	1735 HECKER PASS		TELEPHONE:	(408) 847-8463
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	50	CENSUS: 32	DATE:	05/09/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:34 AM
MET WITH:	Jenny Mosher		TIME COMPLETED:	01:30 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) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Director Jenny Mosher and explained the reason for the inspection. Present during today's inspection were 32 children and at least five staff present. There is an area to post required postings, such as license, notification of parent's rights, and car seat law. The hours of operation are Monday through Friday 8:30AM to 12:30PM. There is working phone at the facility. LPA reviewed the sign-in/out sheet, which has full legal signature. LPA toured the inside and outside of the center. LPA observed that there was a container of disinfectant on top of the children's sink in Pre-K /TK1 Room, which was accessible. Director removed container to the kitchen, which is off-limits. LPA did not observed any children in the room at the time. LPA discussed with Director that any disinfectant spray or wipes need to be inaccessible to children. There are toys and equipment for children. LPA observed that there was a outlet in Pre-K/TK1 that was cracked. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last disaster drill was conducted on 02/08/2023. Director stated that there are no weapons, such as firearms, stored on the premise. The outdoor area is fenced. Areas around play structure and swings have resilient material. LPA discussed with Director about checking that there is sufficient amount of tan bark under the swings and play structure. LPA observed that there a section in the grass area that has a pile of water. Director stated that the grass area is currently off-limits. Director stated that they have a pump to pump out the water, but will block off the area. -------------------continues on 809 dated 05/09/2023 page 2----------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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: VINEYARD PRESCHOOL	FACILITY NUMBER: 430702374
	VISIT DATE: 05/09/2023

NARRATIVE

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-------------------continuation of 809 dated 05/09/2023 page 1-----------------

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA observed that there were two medications at the center, which were both expired. Director stated that she will notify parents and obtain current medication for children. For IMS information, see PIN 22-02-CCP. 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.

Snacks are provided to parents. Lunch is provided and brought from home. There is a menu posted. Drinking water is provided through individual water bottles, Brita filter, and water fountain. LPA observed that there was a pack of cheese in the Upstairs Room that had a best by date of 04/22/2023. LPA discussed with Director about checking expiration dates of food.

A copy of the facility roster was obtained. Six (6) children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and parent's rights. LPA discussed with Director about what needs to be included in admission agreement. Director will send a copy of updated admission agreement to Licensing once updated.

---------------------continues on 05/09/2023 page 3-------------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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: VINEYARD PRESCHOOL	FACILITY NUMBER: 430702374
	VISIT DATE: 05/09/2023

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---------------continuation of 809 dated 05/09/2023 page 2-----------------------

Three (3) staff files were reviewed during today's inspection. The records reviewed include but not limited to health screening and Mandated Reporter training. S-1 started working on 02/2023. S-1's health screening and TB test is more than a year old. Director stated that she will have S-1 obtain health screening and TB test and send a copy to Licensing.

All staff present have cleared fingerprints. Director 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.

As a result of this inspection, Type B citations were issued. Exit interview conducted and report was reviewed with Director Jenny Mosher. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 05/10/2023 08:25 AM - 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: VINEYARD PRESCHOOL	FACILITY NUMBER: 430702374
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/09/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(g)

Buildings and Grounds

(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, which posed a potential health, safety or personal rights risk to persons in care. LPA observed that there was a container of disinfectant on top of the children's sink in PreK/TK 1 Room, which is accessible to children. There were no children present in the room.
	POC Due Date: 05/16/2023
	Plan of Correction
1 2 3 4	Deficiency was corrected during today's inspection. Director moved disinfectant to the kitchen, which is off-limits to children.

Type B

Section Cited

CCR

101226(e)(3)(A)

Health-Related Services

(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in two out of two objects, which poses a potential health, safety or personal rights risk to persons in care. C-1's medication expired on 10/2022 and C-2's medication expired on 02/2023.
	POC Due Date: 05/16/2023
	Plan of Correction
1 2 3 4	Director submitted proof that parents are obtaining medication. Director will send proof of medication once obtained.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC809 (FAS) - (06/04)

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