434406744-5-16-2019-07-CC-MMAR-BC8RRP-20190516131529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434406744
Report Date: 05/16/2019
Date Signed: 05/16/2019 01:15:45 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:	HORACE MANN STATE PRESCHOOL		FACILITY NUMBER:	434406744
ADMINISTRATOR:	CECILIA SANTOS-CHAVEZ		FACILITY TYPE:	850
ADDRESS:	55 N 7TH ST		TELEPHONE:	(408) 535-6237
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	24	CENSUS: 11	DATE:	05/16/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Dorothy Valenzuela		TIME COMPLETED:	01:20 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	On 05/16/19 at 12:00 PM Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Annual inspection of Horace Mann State Preschool. LPA met with Room Teacher, Dorothy Valenzuela and explained the purpose of today's inspection. Facility’s License, Parents’ Rights Poster, Personal Rights, Activity Schedules and Menus were observed to be posted. Facility's operating days and hours are Monday to Friday in two sessions: Morning 8:00 AM - 11:00 AM and Afternoon 12:00 PM - 3:00 PM in Room 113. There are active waivers on file for use of elementary school bathroom and playground. The preschool is located in the premises of Horace Mann Elementary School and operates under the San Jose Unified School District. All staff have Caregiver Background Checks issued by the State Department of Education. The physical plant was inspected. LPA toured the preschool room 113 with Dorothy. Indoor space: The classroom, restroom, were inspected. The afternoon session was starting and children were arriving. LPA observed all children were signed in by their authorized representative. There were 11 children and 3 staff members present at time of inspection. Facility was observed to be in compliance with teacher/children ratio requirement during LPAs' inspection. A staff member was bringing lunch boxes which is provided by the Elementary School Cafeteria. Children ate their lunch and later engaged in various activities under the visual supervision of the teachers. There was a covered water table. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. 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 is situated inside the classroom and was observed to be in safe, sanitary, and in functioning condition. Children wash their hands in the sink located outside the restroom. Floors were clean and free from tripping hazard. Trash cans for solid waste had tight-fitting covers on and were in good repair. Dorothy stated that facility does not possess nor store any weapons on the premises. 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 05/02/19. Facility does not provide transportation for children, but Dorothy understands that children cannot be left alone, unattended in parked vehicles. Continued on Page 2. report dated 05/16/19

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

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: HORACE MANN STATE PRESCHOOL	FACILITY NUMBER: 434406744
	VISIT DATE: 05/16/2019

NARRATIVE

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Outdoor Space: Outdoor playground 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. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities. Children have access to bottled water, own water bottles and water fountain in the classroom.
Files Review: Children sign in and out procedures and logs were reviewed. A sampling of seven Children's files and three Staff files was taken for review. Child records had Admission Agreement, current Immunizations. All teachers have current certification in Pediatric CPR and First Aid and necessary educational qualifications. Children's Roster was reviewed, and a copy obtained.

The facility does not currently have children in care who require Incidental Medical Services. LPA reviewed storage of medication and equipment / supplies. Isolation of sick child was discussed, and Dorothy stated that a sick child is brought to the library area with a dedicated mat and blanket for comfort. Parents are notified and the children restroom is used if necessary. Child is always under visual supervision while being cared for.
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.

In the areas that were evaluated, no regulatory violations were observed. Exit Interview was conducted, where this report was reviewed and discussed with Dorothy who signed the report confirming receipt of documents.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2019

LIC809 (FAS) - (06/04)

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