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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400443
Report Date: 07/08/2021
Date Signed: 07/08/2021 03:53:34 PM

Document Has Been Signed on 07/08/2021 03:53 PM - 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:MORGAN HILL PRESCHOOL ACADEMYFACILITY NUMBER:
434400443
ADMINISTRATOR:CARLA AMESFACILITY TYPE:
850
ADDRESS:17780 MONTEREY ROADTELEPHONE:
(408) 779-5333
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 39TOTAL ENROLLED CHILDREN: 0CENSUS: 18DATE:
07/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Carla Ames and Sandra TIME COMPLETED:
03:55 PM
NARRATIVE
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1Licensing Program Analysts (LPAs) Samantha Yip and Janette Cruz conducted an unannounced Required- 1 Year inspection. LPA met with Cristina August and explained the reason for the inspection. Licensee Carla Ames arrived shortly after. Upon arrival of inspection, there were 18 napping children and 1 staff. Three more staff arrived shortly after. Facility was in ratio during today's inspection.

There is board to post required posting. LPAs reviewed sign in/sign out sheet. The hours of operation are Monday through Friday 7AM to 6PM.

LPAs toured in the inside and outside of the facility with Licensee Carla Ames. The facility was observed to be clean. All toys and equipment were observed to be in good condition. All disinfectant, cleaning supplies, or other items that are dangerous to children were observed to be inaccessible to children. Licensee stated that the last fire/disaster drill was conducted on 06/2021. LPA reminded that fire/disaster drills need to be documented. Licensee stated that she will send fire/disaster drill log to Licensing. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. There are no firearms, such as firearms, stored at the facility.

The outdoor area activity is fenced. Areas around climbing structures have resilient material around it. Shaded rest area is provided through trees and building overhang. LPA reminded Licensee to check the wooden steps going down to the outdoor area for any wear and that all nails are hammered in. There were no bodies of water observed during today's inspection.

------------------------CONTINUES ON 809 DATED 07/08/2021 PAGE 2---------------------------
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2021
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 3
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: MORGAN HILL PRESCHOOL ACADEMY
FACILITY NUMBER: 434400443
VISIT DATE: 07/08/2021
NARRATIVE
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----------------------CONTINUATION OF 809 DATED 07/08/2021 PAGE 1------------------------
Facility only provides snacks to the children. All meals are prepared and brought from home. Drinking water is provided through water cooler, cups, and individual water bottles.

Facility does provide Incidental Medical Services (IMS). All medication was in their original packaging and the parent consent form.

10 children's files were reviewed during today's inspection. The records reviewed include but not limited to the physician reports.

2 staff files were reviewed during today's inspection. The records reviewed include but not limited Mandated Reporter training and immunization records. Licensee stated all the staff completed the Mandated Reporter training on 03/2019. LPA reminded Licensee that the Mandated Reporter Training needs to be renewed every two years. Licensee stated that she will have her staff complete the training and send proof to Licensing. LPA also reminded staff that immunization records for measles and pertussis needs to be in file. LPA observed that S-1 did not have immunization records in file. There is at least one staff with a valid CPR/1st Aid, which expires on 08/24/2021.

All staff present during today's inspection have cleared criminal record clearance and child abuse index. LPA also reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

In the areas evaluated during today's inspection, a Type B citation was issued. A exit interview was conducted with Sandra Rubio, where this report, citation, plan of correction, and appeals rights were discussed and provided to Sandra Rubio. A Notice of Site Visit has been issued and must be posted for 30 consecutive days.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/08/2021 03:53 PM - It Cannot Be Edited


Created By: Samantha Yip On 07/08/2021 at 03:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MORGAN HILL PRESCHOOL ACADEMY
FACILITY NUMBER: 434400443

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2021
Section Cited
HSC
1596.8662(b)(1)

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AB 1207 Mandated Child Abuse Reporting Training. 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 renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement was not met as evident by:
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By POC 08/23/2021, Licensee stated that all staff will completed renewal of the Mandated Reporter training and send proof to Licensing.
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Based on record review and interview, Licensee stated that all staff last completed the Mandated Reporter training on 03/2019. This poses a potential risk to the health and safety 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:Anthony Studebaker
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2021


LIC809 (FAS) - (06/04)
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