434408733-8-25-2021-07-CC-JGSS-C68R25-20210825123746

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408733
Report Date: 08/25/2021
Date Signed: 08/25/2021 12:37:51 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:	CASTLEMONT PRESCHOOL		FACILITY NUMBER:	434408733
ADMINISTRATOR:	ANA GARVAN-ARROYO		FACILITY TYPE:	850
ADDRESS:	3040 EAST PAYNE AVENUE		TELEPHONE:	(408) 364-4233
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY:	60	CENSUS: 14	DATE:	08/25/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Sherry Gallab, Preschool Specialist		TIME COMPLETED:	12:47 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	#1 Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year inspection visit at the facility today. LPA met with Sherry Gallab, Teacher/Preschool Specialist and discussed the purpose of the visit. LPA toured the facility inside and outside with Ms. Sherry. The required documents including the facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule are all posted on the bulletin board. Classroom A is currently closed and not being used. Only classroom B is currently being used and it was observed to be clean and in good order. The classroom has a solid waste container with tight-fitting lid. Children's bathrooms are clean, sanitary, and operable. Chemicals and cleaning supplies are stored on the high shelves that are inaccessible to children. The facility has a lock box that can be stored for any medication if needed. Furniture, tables and play equipment are in good condition and safe for the children. The facility has fire extinguisher, smoke and carbon monoxide detectors and first kid. The food preparation and storage areas are clean. All food and beverages that require refrigeration are stored in covered containers. Drinking water is available for the children in the classroom and outdoor playground area via water bottles and the children's drinking bottles. The playground area is surrounded and secured by steel fencing. The play equipment is age appropriate and in good condition. There is sufficient resilient materials in the outdoor playground area. The are no bodies of water observed. Continued on next page.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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: CASTLEMONT PRESCHOOL	FACILITY NUMBER: 434408733
	VISIT DATE: 08/25/2021

NARRATIVE

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A copy of the children's roster was obtained. Seven (7) children's and 4 staff files were reviewed during today's inspection.

Children's 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 Health Screening Report with TB Clearance, Immunization (Measles, Pertussis, and Flu) record, CPR/First Aid and Mandated Reported Training, Curriculums and qualifications.

Staff understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. Staff stated that they are not providing (Incidental Medical Services) IMS at this time.

LPA reviewed with staff the violations that would result in an immediate assessment of civil penalty in the amount of $500. 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

Care providers are encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources on Regulations, Adoptions of new laws, pay annual fees etc.

As a result of today's inspection, no deficiencies cited. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

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