434406735-7-28-2021-07-CC-MMOO-C5CQAR-20210728120021

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434406735
Report Date: 07/28/2021
Date Signed: 07/28/2021 12:00:28 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:	FOREST HILL PRESCHOOL		FACILITY NUMBER:	434406735
ADMINISTRATOR:	HEATHER ELSTON		FACILITY TYPE:	850
ADDRESS:	4450 MCCOY AVENUE		TELEPHONE:	(408) 364-4279
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95130
CAPACITY:	60	CENSUS: 20	DATE:	07/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Virginia Eigen		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	#2 Licensing Program Analysts (LPAs), Marilou Monico and Cortney Nelson, conducted an unannounced Required - 1 Year inspection. LPAs met with Child Development Specialist, Virginia Eigen, and informed her the purpose of the today's inspection. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, waivers, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The center is open Monday through Friday from 07:00 AM to 05:00 PM. Age serve is two years to kindergarten. LPAs toured the facility both indoor and outdoor. LPAs observed that the facility was operating in compliance with teacher to children ratio requirement. Children were engaged in activities under the supervision of teachers. There were no bodies of water observed. Per Child Development Specialist, there are no weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Children's restrooms were observed to be in operating conditions. Outdoor activity space is enclosed by fencing and is observed to be free of hazards. LPAs observed play equipment were in good condition and areas around the slide have rubber tiles as resilient material. Drinking water was readily available to children indoor and outdoor. Activities schedule and Menus were posted. Facility provides breakfast and lunch or parents have the option to bring breakfast and lunch for their children. Breakfast and lunch are delivered to the facility from the central kitchen of Campbell Union School District . LPAs observed that food storage areas were clean. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on, and were in good repair. First Aid Kit was inspected. Fire extinguisher, smoke and carbon monoxide detectors were observed. Continuation on next page:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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: FOREST HILL PRESCHOOL	FACILITY NUMBER: 434406735
	VISIT DATE: 07/28/2021

NARRATIVE

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The facility has Incidental Medical Services Plan. Child Development Specialist states that none of the children enrolled are currently using medication.

LPAs reviewed sign in and out sheets. A sampling of children and staff files was taken for review during today's inspection. Children records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment, and Immunization.

Staff records reviewed include Criminal Record and Child Abuse Index Clearance, Health Screening Report with TB Clearance, Immunization (Measles, Pertussis, and Flu) record and required Training. LPAs reminded Child Development Specialist that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

Fingerprint clearances for individuals at this facility who require caregiver background checks are issued by the State Department of Education and/or County Office of Education and do not come under the jurisdiction of Community Care Licensing division.

Child Development Specialist to submit updated Personnel Report (LIC 500) and Emergency Disaster Plan (LIC 610) to Licensing by August 4, 2021.

In the areas that were evaluated, there were no deficiencies cited.

A copy of this report was provided to the facility at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED. CHILD DEVELOPMENT SPECIALIST WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC809 (FAS) - (06/04)

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