434404309-9-20-2021-07-CC-PHEZ-C72RLJ-20210920130713

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404309
Report Date: 09/20/2021
Date Signed: 09/20/2021 01:07:24 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:	WASHINGTON PRESCHOOL		FACILITY NUMBER:	434404309
ADMINISTRATOR:	MORENO, AL		FACILITY TYPE:	850
ADDRESS:	100 OAK STREET		TELEPHONE:	(408) 535-6261
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95110
CAPACITY:	23	CENSUS: 15	DATE:	09/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Nardinder Pabla		TIME COMPLETED:	01:07 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	Licensing Program Analyst (LPA) Pete Hernandez conducted an unannounced Required 1 Year inspection of the Preschool today. LPA met with Site Administrator , Narinder Pabla and explained the purpose of today's visit. Also Present was one Teacher by the name of Graciela Guerra. Facility’s License, Parents’ Rights Poster, Personal Rights, Activity Schedules, were observed to be posted. This preschool operates under Title 5 Regulations under San Jose Unified School District and is located in the premises of Washington Elementary School. Facility operations 2 shifts: Monday to Friday 8:00 - 11:00 AM and next, 12:00 PM - 3:00 PM. Present today were 15 children and 2 Staff [1 Site Administrator, 1 I.A teachers]. Facility was observed to be in compliance with teacher to children ratio requirement during LPAs' inspection. Children were engaged in various activities under the visual supervision of the teachers. The physical plant was inspected. Preschool uses Room F4 only with capacity for 23 children. The classroom, restroom were inspected. There are no active waivers on file. Facility does not possess nor store any weapons on the premises. Disinfectants, cleaning solutions, poisons and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Narinder Pabla stated that she has no children enrolled who need IMS care. Medications, if any are stored in a locked cabinet, out of reach from children. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restroom for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

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: WASHINGTON PRESCHOOL	FACILITY NUMBER: 434404309
	VISIT DATE: 09/20/2021

NARRATIVE

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Outdoor activity space was inspected and observed to be safe. The play equipment was maintained in good condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. Drinking water is arranged to be readily available to children during indoor and outdoor activities using fountains. No water bodies were observed.

The preschool serves two meals: breakfast and lunch, which is supplied by the cafeteria on premises of the elementary school. Food is wheeled into the classroom during meal service. Trash cans for solid waste had tight-fitting covers on and were in good repair.

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.

Facility does not provide transportation for children, but Narinder Pabla understands that children cannot be left alone, unattended in parked vehicles.

LPA observed a 3A40BC Fire extinguisher, Smoke and Carbon Monoxide Detectors, fire pull stations, and sprinkler system. Log shows that the last Fire Drill was conducted on /16/2021.

Children sign in and out procedures and logs were reviewed. A sampling of 5 Children's files and 2 Staff files was taken for review. All children files had information about name, address, authorized representative of child, and medical assessments on file. Staff files had current CPR/First Aid certifications and Health Screening Reports. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

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: WASHINGTON PRESCHOOL	FACILITY NUMBER: 434404309
	VISIT DATE: 09/20/2021

NARRATIVE

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Staff has finger print clearances through the San Jose Unified School District.

Licensee does have current Mandated Reporter Certificate. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

TYPE A language: Should there ever be issuance of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview and copy of this report was discussed and left with the Licensee, Nardinder Pabla, whose signature on this form confirm receipt of these documents.

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

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

LIC809 (FAS) - (06/04)

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