434408057-9-10-2019-07-CC-PTIG-BFVVFH-20190910162359

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408057
Report Date: 09/10/2019
Date Signed: 09/10/2019 04:24:08 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: 13	DATE:	09/10/2019
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Bonnie Potenza		TIME COMPLETED:	04:30 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 and case management annual continuation Inspection at the facility today. This continuation inspection was prompted by the fact that the children were not yet attending school at the inspection dated 08/26/2019. Upon arrival in front of classroom 2 at 12:20 PM, Director Bonnie Potenza greeted us and invited us inside. 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), Personnel Report, 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. Upon arrival, LPA and LPM observed 3 children in room 2 with a teacher and 10 children in room 1 with two teachers. Some children in room 1 were finishing their lunch while other children were preparing for nap time. The children in these two rooms were full time students, meaning that they are at school the whole day. 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 snack menus and daily schedule are posted. She stated that all staff are aware of food allergies or dietary restrictions, which are outlined in children's files. 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 09/10/2019

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Peter Tinkelenberg	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019

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: 09/10/2019

NARRATIVE

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Continued from page 2 dated 09/10/2019

LPA and facility representatives discussed transition protocol, including direct supervision of children at all times and name to face for all transitions.

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.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

No deficiencies were cited today.

A Notice of Site Visit has been issued and must remain posted for 30 consecutive days.

Exit interview conducted with Ms. Bonnie Potenza, Director .

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Peter Tinkelenberg	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019

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: 09/10/2019

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Per Director, there are no weapons on site. LPA did not observe 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 on 03/14/2019 as well. 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 09/10/2019 in the morning.

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 facility maintains an updated roster of children in the program. LPA observed that the children on the roster is consistent with the children in the classroom and with the electronic sign-in. The facility maintains an electronic sign in and out system, that is updated throughout the day, containing secured Pin numbers from responsible parties. The Director stated that she understands that the facility is responsible for ensuring each child is signed in and out by their responsible party. The facility was able to provide a hard copy of the children on the electronic roster. Thirteen children's files were inspected. LPA observed that the records of each child is complete.

The program does include off site field trips and LPA and the Director discussed parent chaperones and supervision away from the facility premises. LPA and the facility representatives discussed emergency disaster drills and preparedness, children's personal rights including no corporal punishment, forms of discipline, and healthy beverages in child care. 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 via pitchers, cups, and water fountains, and there is also sufficient covering for shade.
Continued on page 3 dated 09/10/2019

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Peter Tinkelenberg	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019

LIC809 (FAS) - (06/04)

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