430710428-2-28-2020-07-CC-DVIA-BM8VBZ-20200228151821

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710428
Report Date: 02/28/2020
Date Signed: 02/28/2020 03:18:29 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:	GRANT STATE PRESCHOOL		FACILITY NUMBER:	430710428
ADMINISTRATOR:	ROSEMARY ZAVALA		FACILITY TYPE:	850
ADDRESS:	470 JACKSON STREET		TELEPHONE:	(408) 293-7955
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	48	CENSUS: 10	DATE:	02/28/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Virginia Solano-Bean		TIME COMPLETED:	03:30 PM

NARRATIVE

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Licensing Program Analyst (LPA), Deanna Villagrana, conducted an unannounced one year required visit to the Facility today. LPA met with Virginia Solano-Bean, director, and explained the nature of today's visit to her. The Facility is licensed in rooms A and B located at Grant Elementary. The playground area of the Facility is located to the right side of the rooms. LPA notes that the Facility has two sessions, one from 8:00am-11:00am to 12:00pm-3:00pm Monday through Friday. Teachers have background checks and cleared through San Jose Unified School District.
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.

LPA reviewed five children's and two staff (1 director & 1 teachers files during today's inspection. All staff and children's files were complete. Staff have current CPR and First Aid certifications on file all staff files reviewed contain the required transcripts/verification of experience. Virginia 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 ten preschool children with director, one teacher and student teacher in room A. Virginia understands the conditions, limitations, and capacity specifications of the Facility license. At 2:30pm LPA observed a child ask teacher 2 to use the bathroom. Teacher told child to go. Child entered the bathroom and closed the door. Child was unsupervised while using the bathroom. LPA informed Virginia of the situation. LPA observed that both rooms are clean and safe for all children and staff. Virginia states that the Facility is cleaned by janitorial service provided by the school. Drinking water is readily available for the children in each room and in the outdoor playground area via fountain. LPA observed solid waste containers with tight-fitting lids in the Facility. Staff and children's bathrooms are clean, sanitary, and operable. Virginia states that there are no weapons or firearms on the premises.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020

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: GRANT STATE PRESCHOOL	FACILITY NUMBER: 430710428
	VISIT DATE: 02/28/2020

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Children bring their lunch from home or purchase lunch from school cafeteria. No snacks are provided by preschool. Cleaning supplies are inaccessible to the children and stored in locked cabinets. Any medications at the Facility are stored in a locked cabinet. 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 large canopy, several trees and the building overhang provide shade for the day care children. LPA did not observe any bodies of water.

The following type A deficiency was cited on the attached page (809-D).

An exit interview was conducted and Plan of Correction was reviewed and developed with Virginia. A copy of this report and appeal rights were discussed and left with Virginia, whose signature on this form confirm receipt of these documents.

LPA also advised Virginia that Mandated Reporter must be completed from an approved program or until a waiver is approved. Training can be found at mandatedreporterca.com. An advisory note was issued.

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

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020

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: GRANT STATE PRESCHOOL	FACILITY NUMBER: 430710428
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/28/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/29/2020 Section Cited	1 2 3 4 5 6 7	101229(a)(1) Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).
	8 9 10 11 12 13 14	This requirement was not met as evidenced by Child was unsupervised while using the bathroom. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.	8 9 10 11 12 13 14	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 Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020

LIC809 (FAS) - (06/04)

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