434408057-8-26-2019-07-CC-PTIG-BFES6U-20190826133630

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408057
Report Date: 08/26/2019
Date Signed: 08/26/2019 01:36:49 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:	MULBERRY SCHOOL		FACILITY NUMBER:	434408057
ADMINISTRATOR:	BONNIE POTENZA		FACILITY TYPE:	850
ADDRESS:	220 BELGATOS ROAD		TELEPHONE:	(408) 358-9080
CITY:	LOS GATOS	STATE: CA	ZIP CODE:	95032
CAPACITY:	45	CENSUS: 0	DATE:	08/26/2019
TYPE OF VISIT:	Annual/Required	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Bonnie Potenza		TIME COMPLETED:	01:45 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) Peter Tinkelenberg and Licensing Program Manager Diana Stephenson conducted an Unannounced Annual/Required Inspection at the facility today. Upon arrival, LPA observed no preschool age children as school officially begins 09/03/2019. We introduced ourselves to Bonnie Potenza, Director. LPA toured the facility inside and out and observed required postings including but not limited to; the License to operate, Emergency Disaster Plan (LIC 610) and Notification of Parents Rights (PUB 393). Days and hours of operation are Monday through Friday 8:00 am to 4:30 pm. The facility is licensed to serve a maximum of forty five (45) children ages two (2) to five (5) years old in classrooms 1 & 2. Since school is not yet officially in session, LPA was not able to observe compliance with ratio and supervision requirements during today's inspection. This will be conducted at a later date. The facility was observed to be clean, safe, sanitary, and in good repair. Disinfectants, cleaning solutions, and all other items that are dangerous to children were observed to be securely stored and inaccessible. Indoor and outdoor activity spaces were observed as properly equipped with age appropriate toys and supplies that are in safe condition. The restrooms were observed to be clean and functional, and floors and carpeting are free from hazard and obstruction. The facility prepares and serves afternoon snacks to children. Children's lunches are brought from home. Director Potenza states the facility does not serve milk or juice. Facility menus and daily schedule have not yet been posted but Director Potenza assures LPA that they will be emailed when school begins. She stated that all staff are aware of food allergies or dietary restrictions, which are outlined in children's files and posted in classrooms with parent permission. The Director stated that parents assist with preparing and serving morning snacks and are aware of all dietary restrictions and food allergies. LPA observed that one classroom has a diaper changing station that is equipped with padded surfaces that can be disinfected after each use. Continued on page 2 dated 08/26/2019

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Peter Tinkelenberg	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019

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: MULBERRY SCHOOL	FACILITY NUMBER: 434408057
	VISIT DATE: 08/26/2019

NARRATIVE

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Continued from page 2 dated 08/26/2019

A review of staff records today indicate that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA also discussed and reviewed immunization including Measles, Pertussis, and Influenza. LPA also reminded Licensee 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.

This facility is not providing Incidental Medical Services – IMS at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

The Director has been referred to the department website for Licensing forms, resources, and updates: http://www.cdss.ca.gov/inforesources/Child-Care-Licensing

One Type B deficiency was cited for today's inspection. A Notice of Site Visit has been issued and must remain posted for 30 consecutive days.

Exit interview was conducted with Director Bonnie Potenza.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Peter Tinkelenberg	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019

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: MULBERRY SCHOOL	FACILITY NUMBER: 434408057
	VISIT DATE: 08/26/2019

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Continued from page 1 dated 08/26/2019

Per Director, there are no weapons on site. LPA did not observed any bodies of water on the premises. LPA observed a fire extinguisher, size 3A40BC which was last serviced on 03/14/2019. Smoke detectors are centralized and inspected by the fire department at least once a year. The carbon monoxide detector in each room are working, and complete first aid kits throughout the facility. Emergency disaster drills are performed as required. The facility maintains logs of emergency disaster drills and procedures and was last conducted on 7/11/19. Since school is not yet in session, and no children were observed in the classrooms, the LPA did not inspect children's files, which will be conducted on a later date.

Administration and staff records were reviewed. LPA reviewed the director's file and four teacher files and observed that the director and three teachers have current CPR/First Aid certification on file. The opening and closing teachers each have current CPR/First Aid certification. The facility does not provide transportation to children.

The program does include off site field trips. However, Director Potenza states parents are required to go on the field trips with their child. Children who don't have parents to take them on the field trip stay in school with a qualified teacher. LPA and the Director discussed emergency disaster drills and preparedness, emergency lock-down procedures, children's personal rights including no corporal punishment, forms of discipline, healthy beverages in child care, and recent updates to the child seat belt law. LPA toured the outdoor play area, which was observed to be safe and equipped with age appropriate toys and equipment. There is secure perimeter fencing and play structures and equipment appeared to be in safe condition. LPA observed that there is sufficient absorbent materials, drinking water available for children inside and outside, and there is also sufficient covering for shade. LPA and facility representatives discussed transition protocol, including direct supervision of children at all times and name to face for all transitions.

Continued on page 3 dated 08/26/2019

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Peter Tinkelenberg	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019

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: MULBERRY SCHOOL	FACILITY NUMBER: 434408057
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/26/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/03/2019 Section Cited	1 2 3 4 5 6 7	101217(a) Personnel Records. Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on inspection of personnel records, Licensee failed to provide LIC 501 (Personnel Record) for S-2 and S-5, whic poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
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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: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Peter Tinkelenberg	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019

LIC809 (FAS) - (06/04)

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