434408734-10-9-2019-07-CC-SCRL-BGSQGS-20191009121002

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408734
Report Date: 10/09/2019
Date Signed: 10/09/2019 12:10:10 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:	MARSHALL LANE PRESCHOOL		FACILITY NUMBER:	434408734
ADMINISTRATOR:	HEATHER ELSTON		FACILITY TYPE:	850
ADDRESS:	14114 MARILYN LANE		TELEPHONE:	(408) 364-4259
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	48	CENSUS: 27	DATE:	10/09/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jessica Alexander		TIME COMPLETED:	12:25 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), Stephanie Rangel, conducted an annual random inspection. LPA met with Lead Teacher/On-site supervisor, Jessica Alexander and Preschool Coach, Lisa Niles. The center is located at Marshall Lane Elementary School site. LPA observed all the required posted materials. LPA toured the facility both indoor and outdoor. The teacher-child ratio was in compliance. Staff provide adequate supervision. At least one staff member present during the inspection (Jessica Alexander) has current CPR and First Aid certifications that expire 1/23/20. LPA reviewed ten children's and four staff files during today's inspection. The rooms are clean and orderly. Coach and Site Supervisor state that the Facility has in-house cleaning service that cleans the Facility Monday through Friday in the evenings. Drinking water is readily available for the children indoor and outdoor via drinking fountains. Staff states that there are no weapons on the premises. Cleaning supplies are stored in the upper cabinet in the kitchen inaccessible to children. Parents provide snacks and lunch for their children. There is a functioning carbon monoxide and smoke detector at the facility. LPA reviewed the sign in/out sheets and children's roster. There are sufficient tanbark as resilient material under the climbing structure. No bodies of water were observed. LPA discussed the requirements Mandated Reporter Training and SB 792 - Immunizations Needed for Staff. Report continued on the following page:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019

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: MARSHALL LANE PRESCHOOL	FACILITY NUMBER: 434408734
	VISIT DATE: 10/09/2019

NARRATIVE

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Report continued from from the previous page:

Incidental Medical Services plan of operation is on file.

Fingerprint clearances for individuals working at the facility are issued by the State Department of Education and do not come under the jurisdiction of Community Care Licensing Division.

Facility is giving out the Effect of Lead Exposure handout dated 1/20/19. Facility understands that per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians.

Deficiency cited during today's inspection. Appeal rights printed and reviewed.

Facility was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

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

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019

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: MARSHALL LANE PRESCHOOL	FACILITY NUMBER: 434408734
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/09/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/16/2019 Section Cited	1 2 3 4 5 6 7	Sign in and Sign Out: The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. This requirement was not met as evidenced by some children not being signed in/or out per title 22 regulations. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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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: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2019

LIC809 (FAS) - (06/04)

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