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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403520
Report Date: 06/13/2019
Date Signed: 06/13/2019 04:08:58 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:MY PRESCHOOLFACILITY NUMBER:
434403520
ADMINISTRATOR:HADIAN, SOHAYLAFACILITY TYPE:
850
ADDRESS:1472 SARATOGA AVENUETELEPHONE:
(408) 376-0385
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:50CENSUS: 31DATE:
06/13/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Sohayla Hadian & Alba SalernoTIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Stephanie Rangel met with owners, Sohayla Hadian and Alba Salerno for an annual random inspection. LPA toured the Facility both inside and outside. LPA notes the following rooms are in use in the preschool program: 2's, 3's/4's room. LPA observed all the required posted materials including the facility license, Emergency Disaster Plan, Earthquake Preparedness Checklist, Notification of Parents' Rights, menu, Personal Rights and activity schedule.

LPA reviewed 10 random children's files and 5 staff files. Facility was in compliance with SB 792 (vaccinations needed for child care workers). Director has current CPR and First Aid certifications that expire 2/11/21. LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA reviewed the sign in and sign out sheets and children's roster.

The rooms are clean. Staff and children's bathrooms are sanitary and operable. Drinking water is readily available for the children indoor and outdoor via personal water bottles and water fountains. The center provides snacks. Cleaning supplies are kept in the janitorial closet inaccessible to children. Janitorial service is provided weekdays in the evening.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe. Shade is provided by building overhang, umbrellas, canopies and trees. LPA observed that the outdoor equipment is age appropriate and in good condition. LPA observed wood chips as resilient material. Director stated that there are no weapons on the premises.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06/13/2019):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
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: MY PRESCHOOL
FACILITY NUMBER: 434403520
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2019
Section Cited
CCR
101170(e)(1)
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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department
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Director stated that this person was used in their ratio for a half a day from another preschool. Licensee shall review regulations, and submit a letter of understanding outlining how this will be avoided in the future by the POC date. $100.00 civil penalty assessed today.
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This requirement was not met as evidenced by one person wwho as used in ratio that was not associated to the preschool nor the infant license. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
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: MY PRESCHOOL
FACILITY NUMBER: 434403520
VISIT DATE: 06/13/2019
NARRATIVE
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 06/13/2019):

A review of staff records during today's inspection indicates that not all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA 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 violations within a 12 month period.

IMS plan is on file.

LPA conducted an exit interview with the director prior to the conclusion of today's inspection and advised the director of the required "mandated reporter" training for CA Child Care Workers for AB 1207 that all Licensees and staff are required to complete every two years as of January 1, 2018. The website for the online training is: http://www.mandatedreporterca.com



As a result of this inspection, Deficiencies cited on the following. Appeal rights printed and reviewed.

Periodic information releases accessible by signing up at: www.myccl.ca.gov

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
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: MY PRESCHOOL
FACILITY NUMBER: 434403520
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/25/2019
Section Cited
HSC
1596.8662(b)(1)
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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)n and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Director stated the she and her staff will complete the mandated reporter training for AB 1207 and submit proof of completion of training to CCL by POC due date of 7/25/19
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This requirement was not met as evidenced by the Licensee not being able to show proof of completion of mandated reporter training. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Type B
06/20/2019
Section Cited
CCR
101217(a)
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Personnel Records. Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information.
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Director shall review regulations, and submit a letter of understanding outlining how this will be avoided in the future by the POC date.
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This requirement was not met as evidenced by the director not being able to show proof of a personnel file for one person in ratio at the facility. This poses a potential risk Health, Safety Personal Rights risk to 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 StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4