434406735-5-1-2024-07-CC-MMOO-D4UR2T-20240501123851

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434406735
Report Date: 05/01/2024
Date Signed: 05/01/2024 12:39:00 PM

Document Has Been Signed on 05/01/2024 12:39 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:	FOREST HILL PRESCHOOL		FACILITY NUMBER:	434406735
ADMINISTRATOR/ DIRECTOR:	HEATHER ELSTON		FACILITY TYPE:	850
ADDRESS:	4450 MCCOY AVENUE		TELEPHONE:	(408) 364-4279
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95130
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 23	CENSUS: 18	DATE:	05/01/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:13 AM
MET WITH:	Olga Duran		TIME VISIT/ INSPECTION COMPLETED:	12:55 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) Marilou Monico met with Lead Teacher, Olga Duran, for an unannounced Annual Random Inspection. The purpose of today's inspection was explained with Olga. Facility's License, Notification of Parents’ Rights Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The preschool program has active waivers: to share the playground with another program and to allow ill children to use one of the four preschool toilets and hand washing fixtures as needed. The center's operating hours are Monday through Friday from 07:00 AM to 5:00 PM. The facility is licensed to serve children ages 2 years to kindergarten in Rooms E, D, C, and B. LPA toured the indoor and outdoor areas. LPA observed that the teacher-child ratio was in compliance. Fire drill was conducted on April 18, 2024. The facility has current children's roster and a copy was provided to LPA during the inspection. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The facility is clean. The bathrooms for children and staff are clean, sanitary, and operable. Olga stated that the Forest Hill Elementary janitorial service comes and clean the facility after daycare hours. The center provides morning snacks, lunch, and afternoon snacks to the children. Olga stated that snacks and lunch are catered to the center from Forest Hill Elementary School cafeteria. Drinking water is available for the children indoor via individual water bottles. LPA observed trash cans with tight fitting covers for the disposable of solid wastes. The facility has fire extinguishers and working smoke and carbon monoxide detectors. *Continuation on next pages:*

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024

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: 05/01/2024

NARRATIVE

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The playground is surrounded with appropriate fencing and the outdoor surfaces are safe. Shade is provided by trees and building overhang. Drinking water is readily available for the children via individual water bottles. LPA observed climbing structures with resilient material (rubber foam) under and around the structures. There were no bodies of water observed. Olga stated that there are no we weapons or firearms on the premises.

LPA reviewed six (6) random children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment, Physician's Report, TB test, Immunizations, Parent Right's Receipt, Personal Rights, and Health History.

LPA reviewed four (4) staff files. Staff records reviewed include Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza) and required training. LPA reminded Olga that the Mandated Reporter Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed personnel, and administrative records. Olga stated that none of the children enrolled are using medication at this time. 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/resources/child-care-centers/.

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.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024

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: 05/01/2024

NARRATIVE

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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for
lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-
CCP).

During the inspection, LPA spoke with Preschool Assistant Director, Mylene Ignacio, over the phone. Mylene indicated that the preschool building was built after January 1, 2010. LPA requested to submit proof that the building and plumbing were built after January 1, 2010.

Lead Teacher, Olga Duran, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&R's) throughout California.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

As a result of this inspection, there were no deficiencies cited.

The following items to be submitted to Licensing by May 15, 2024:
1) Designation of Facility Responsibility (LIC 308) with original signature of licensee's representative.
2) Permission letter from the two relocation sites listed on the Emergency Disaster Plan (LIC 610).
3) Proof that the preschool building and plumbing were built after January 1, 2020.

Exit interview conducted and report was reviewed with Lead Teacher, Olga Duran.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024

LIC809 (FAS) - (06/04)

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