434400224-10-22-2019-07-CC-AALZ-BH7RDK-20191022125605

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400224
Report Date: 10/22/2019
Date Signed: 10/22/2019 12:56:16 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:	SANTA TERESA STATE PRESCHOOL		FACILITY NUMBER:	434400224
ADMINISTRATOR:	MONIQUE CORELY		FACILITY TYPE:	850
ADDRESS:	6200 ENCINAL DRIVE		TELEPHONE:	(408) 972-4396
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95119
CAPACITY:	45	CENSUS:	DATE:	10/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	Pantoja, Alena		TIME COMPLETED:	01:05 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	An unannounced Annual Random Inspection was conducted on this day, by Licensing Program Analyst (LPA) Almaraz, Araceli. Facility is currently licensed for a capacity of 45. Licensing staff met with Director Corley, Monique. The program currently operates 9AM to 12 PM, Monday thru Friday. Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. At the initial start of this visit, there was a total census of 10 children and a total census of one director and two teachers present. PHYSICAL PLANT This is a Preschool program which consists of one classroom; Room 2 is in a shared portable with room 1, the school age program. The school age program hours are currently 6:30 AM to 8:20 AM and 1:45 PM to 6:00 PM. All areas identified on the Facility Sketch were inspected. Upon arrival, the following staff were present during this inspection: Room 1: Staff #2 and #3 with 10 preschoolers. The following was observed of this room during the inspection of the facility: Furniture and equipment were inspected for age appropriateness and are in sufficient condition. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubicle to store their belongings. Per director, the isolation area is in the office. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Disinfectants, cleaning solutions, medication and other hazardous items that pose a risk to children, were inaccessible to the children in care. Director Corley states that poisons are locked in the lavatory closet. All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition. Director states waste is to be discarded immediately after each meal. First Aid supplies were observed in the classroom in a cabinet. According to Director Corely medication is only administered to a child when accompanied with a doctor's note and is stored in the office. Carbon monoxide detectors and smoke detectors are working and present in the facility. There is a Fire extinguisher size 3A40BC in this room and has been serviced on 04/15/2019. Teacher child ratios were observed, staff names recorded***Page 1/4 Report Continued on Page 2***

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019

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: SANTA TERESA STATE PRESCHOOL	FACILITY NUMBER: 434400224
	VISIT DATE: 10/22/2019

NARRATIVE

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Lavatories: Age appropriate sinks and toilets were inspected for availability and sufficient condition in all lavatories. LPA observed age appropriate sinks and toilets and were inspected for water temperature, toilet paper, area safety and sanitation. There are a total of 1 toilet and 1 sink available for the preschool children. LPA Almaraz observed the children's sinks are in working condition. LPA Almaraz observed soap dispenser and disposable towels in the preschool bathrooms. There is an additional lavatory with one toilet and one sink on the school age side of the portable. Director states since they separate bathrooms, the other can be utilized by sick children if necessary because school age and preschool children are not present at the same time. Director states staff alternates lavatories when preschool children are present they use the school age lavatory and vise versa.

Kitchen: There is one kitchen which is shared with the school age program. All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids or solid waste bags discarded immediately after each meal. Menus are seasonal, posted one month in advance where it is visible by the child's authorized representative. Menus for the last two years are available upon request. Snack menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment. One AM snack served daily. LPA Almaraz concludes, this area is currently in compliance with licensing standards.

Outdoor playground equipment is in a safe condition, free of sharp, defective or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. Director Corely states that this play area is used from 9:35 AM until 10:15 AM, although this area is shared with the transitional kindergarten and the special education preschool ages children, supervision and schedule differentials ensures there is no commingling between programs. The Director states an inquiry will be made regarding updating the cushioning material for the play area. *****Page 2/4 Report Continued on Page 3****

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019

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: SANTA TERESA STATE PRESCHOOL	FACILITY NUMBER: 434400224
	VISIT DATE: 10/22/2019

NARRATIVE

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Licensing will follow up regarding bathrooms and capacity. Director Corley states staff will use the office bathroom of the elementary school and as a sick child bathroom with supervision until further notice. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. The playground floor material should be updated at the earliest opportunity possible. It was discussed there should be a waiver request from provider for shard playground. Director Corely was advised that indoor and outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.

The fire extinguisher type 3A40BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

LPA advised Director Corely that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility. The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised to visit www.shotsforschool.org for immunization information.

These forms may also be downloaded from our website: www.ccld.ca.gov There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1
Exit interview conducted, copy of report was given..

NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.
*****Page 4/4 Report Continued from Page 3, Final Page of Report****

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019

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: SANTA TERESA STATE PRESCHOOL	FACILITY NUMBER: 434400224
	VISIT DATE: 10/22/2019

NARRATIVE

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Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Children's roster was reviewed and is current. Children present were signed in. Sign-in and out sheets and procedures were reviewed. Personal Rights of children were observed by LPA. All required postings posted where parents/guardians can observe them. Disaster drill log was available, last drill was conducted on 10/18/2019.

All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. (All staff have received an active criminal record clearance as a condition of their employment.)

Children’s Records were reviewed for completeness; Inspection of required forms was made. LPA issued the Children’s Record Review (LIC 857) to the director during this inspection. In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

LPA also issued the Review of Staff records (LIC 859) to the director during this inspection. The LIC 857 and the LIC 859 documents the staff and children’s files that were reviewed during this inspection.

This facility provides Incidental Medical Services–IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

The following was discussed with Director Corley: Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited.

*****Page 3/4 Report Continued on Page 4*****

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019

LIC809 (FAS) - (06/04)

Page: 4 of 4