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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709235
Report Date: 01/31/2020
Date Signed: 01/31/2020 05:08:17 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:LAURELWOOD PRESCHOOLFACILITY NUMBER:
430709235
ADMINISTRATOR:LARA HEDLUNDFACILITY TYPE:
850
ADDRESS:955 TEAL DRIVETELEPHONE:
(408) 440-7821
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:36CENSUS: 29DATE:
01/31/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Tarini KumarTIME COMPLETED:
05:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Shannel Reed met with Teachers, Rebekah Pike and Tarini Kumar for an unannounced annual/random inspection. Ms. Pike informed LPA that the Site Director, Lara Hedlund, is not on site. LPA later spoke with Ms. Hedlund and she stated that she often works from home and that the facility does not have an onsite Director, and that she would not be able to be on site for the inspection. LPA continued the inspection with Teacher, Tarini Kumar.

The centers hours of operation are Monday, Wednesday, Friday, 8:30am -11:30pm and 12Pm -3PM. Tuesday and Thursday from 8:30AM – 11:00AM and 12:00PM -2:30 PM. The Preschool is located on site at Laurelwood Elementary school in rooms P1, and P2. LPA toured the Facility both inside and outside during todays visit. 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.

LPA observed that the teacher/adult to child ratio was in compliance during today’s visit with two teachers and five (5) “working parents” and 29 children. This is a parent involvement program. Ms. Kumar understands the conditions, limitations, and capacity specifications of the Facility license. The Ms. Kumar understands that children shall be visually supervised at all times and never left unattended.

A review of staff records 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 reviewed six (6) preschool teacher staff files. Five of the teachers are missing the required Mandated Reporter training.
Facility Evaluation Report dated 01/31/20 to be continued on next page:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020
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: LAURELWOOD PRESCHOOL
FACILITY NUMBER: 430709235
VISIT DATE: 01/31/2020
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Facility Evaluation Report dated 01/31/20 continued from previous page:
LPA also observed that no teacher has the required CPR/ first Aid certificate of training on file. Ms. Kumar states that they all have it, but she is unsure as to where the certificates are. Ms. Kumar 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 classrooms are clean and safe for all children and staff. LPA observed solid waste containers with tight-fitting lids in the classroom. Children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed located on site. Drinking water is readily available for the children inside and outside via personal water bottles. LPA observed solid waste containers with tight-fitting lids in the classroom.
LPA reviewed five (5) children’s files. All files have the required documentation and immunization's.
Ms. Kumar states that there are no weapons on the premises. Snacks are provided by the parents for the children in care. Food is stored in the on-site refrigerator in P1. The food preparation area is equipped with a hot and cold running water and a microwave. Cleaning supplies are stored inaccessible to the children. Ms. Kumar states that no medication is given or stored on site. First Aid kit is stored in the classroom. Ms. Kumar states that the classrooms are cleaned by the school janitors Monday through Friday in the evenings. 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. LPA observed no bodies of water.
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the Licensee can obtain updated licensing information, new regulations and access forms. LPA advised the Licensee of their responsibility to stay current in regard to new regulations. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list childcareadvocatesprogram@dss.ca.gov. LPA discussed and provided Lead Safety information (AB 2370).
LPA was unable to obtain a Facility roster because the Ms. Kumar stated that the facility does not have one. LPA conducted an exit review Ms. Kumar.
Title 22 Deficiencies were observed and cited during today’s inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2020
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: LAURELWOOD PRESCHOOL
FACILITY NUMBER: 430709235
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2020
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a) and shall complete renewal mandated reporter training every two years.
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This requirement is not met as evidenced by: LPA observed that five of the teaching staff have not completed required training or have expired Mandated Reporter training on file. This is a potential risk to the children in care and a deficiency to the Health and Safety regulations.
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Type B
02/28/2020
Section Cited

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Child Care Center Directors Qualifications and Duties: The child care center director, or the substitute director as specified in (f) below, shall be on the premises during the hours the center is in operation. This requirement is not met as evidenced by: Site Director, Lara Hedlund stated that she often works from home and that the facility does
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not have an onsite Director.This is a potential risk to the 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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2020
LIC809 (FAS) - (06/04)
Page: 4 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: LAURELWOOD PRESCHOOL
FACILITY NUMBER: 430709235
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2020
Section Cited

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Personnel Requirements At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the childcare center or offsite for center activities.
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This requirement is not met as evidenced by:LPA observed that no teacher has the required CPR/ first Aid certificate of training on file. This is a potential risk to the children in care.
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Type B
02/28/2020
Section Cited

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Current roster of children provided care in facility required: Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician.
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This roster shall be available to the licensing agency upon request.
This requirement is not met as evidenced by: The facility staff could not provide LPA with a Facility roster, and stated that they do not have one. This is a potential risk to the children in care and a deficiency to the Health and Safety regulations.
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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4