434400281-10-15-2019-07-CC-NROZ-BGYPA8-20191015110818

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400281
Report Date: 10/15/2019
Date Signed: 10/15/2019 11:08:28 AM

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:	EL TORO CDC - STATE PRESCHOOL		FACILITY NUMBER:	434400281
ADMINISTRATOR:	JULIZA PONCE		FACILITY TYPE:	850
ADDRESS:	455 EAST MAIN STREET		TELEPHONE:	(408) 778-1402
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	32	CENSUS: 14	DATE:	10/15/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:59 AM
MET WITH:	Juliza Ponce		TIME COMPLETED:	11:00 AM

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 Analysts Nancy Rodriguez and Samantha Yip met with Katrina Asfour, Teacher, for an annual/random inspection and explained the nature of today’s visit. There are 14 preschool children and 2 staff in attendance. Site Supervisor Juliza Ponce arrived at 10:27AM. Days and hours of operation are Monday - Friday from 8:00 am to 11:00 am. There are no bodies of water or firearms/weapons in the facility. LPA observed a 2A10BC/30A40BC fire extinguisher that was last serviced in May 2019. Smoke detector and Carbon Monoxide detector are operable.Facility is clean and orderly with heating and ventilation for safety and comfort. LPA observed sufficient materials, toys, and play equipment for the preschool children. Each child has safe healthy, and comfortable accommodations, furnishings, and equipment. Telephone is in working order. Medicines, poisons and cleaning supplies are inaccessible to the children. Playground is fenced and appropriate for preschool aged children. Areas around play structure have resilient materials to absorb falls.Shaded rest areas are provided through trees, Menus are posted and snack is prepared in a clean and orderly kitchen. Drinking water is provided through water fountains and water cooler and cups . A listing of staff criminal record clearances associated to this facility in the CCL Licensing Information System (LIS) on 10/15/2019 was reviewed; and it indicates that all Facility staff or other individuals who require caregiver background clearances have received criminal record and child abuse index clearances or exemptions. LPA reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100 per person per day, minimum of $100 to a maximum of $500 per person for an initial violation, and a minimum of $100 to a maximum of $3000 per person for any subsequent violation within a 12-month period. Licensee understands upon notice of the Department to remove an individual from the facility, or to exclude an individual from the facility, the licensee shall immediately remove the individual and prevent them from returning to the facility or having contact with children in care.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Nancy Rodriguez	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

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: EL TORO CDC - STATE PRESCHOOL	FACILITY NUMBER: 434400281
	VISIT DATE: 10/15/2019

NARRATIVE

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LPA received a copy (took a picture) of a current roster of the children and a fire and disaster drill log that was last conducted on September 5, 2019.. LPA reviewed 10 children’s files. Children’s immunization records are documented, maintained, and updated in form PM286. LPA observed Notification of Parents’ Rights is in each child’s file. LPA observed that the staff have completed Mandated Reporter training on January 5 2018. All staff have Pediatric CPR/1^st Aid expiring March 24, 2020. LPA reviewed 3 employee files and observed licensee has all needed documentation for SB 792 which requires immunization against Pertussis, Measles, and Influenza (decline statement) as well as TB testing.

Incidental Medical Services (IMS) policy was discussed with the licensee. The licensee is currently providing IMS (Incidental Medical Services). LPA reviewed medication and observed it has proper documents.

An exit interview was conducted with Site Supervisor, Juliza Ponce, and no deficiencies were cited at this time.

Notice of site visit must remain posted with for 30 days

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Nancy Rodriguez	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

LIC809 (FAS) - (06/04)

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