434408734-8-9-2022-07-CC-PHEZ-CH5S4H-20220809133246

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408734
Report Date: 08/09/2022
Date Signed: 08/09/2022 01:32:55 PM

Document Has Been Signed on 08/09/2022 01:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 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: 20	DATE:	08/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Donna Jackson		TIME COMPLETED:	01:49 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), Pete Hernandez, conducted a Required 1 Year inspection. LPA met with Lead Teacher/On-site supervisor, Donna Jackson, Assistant Director Luwanda Kohrsand, The center is located at Marshall Lane Elementary School site. Operating hours are 7:00AM to 5:00 PM Monday through Friday. LPA observed all the required posted materials. LPA toured the Facility both inside and outside during today's visit. LPA notes that the Facility is licensed in one large preschool room with 1 bathroom inside room A: Preschool room.. LPA observed the required posted materials, 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), Menu, and Activity Schedule. The facility has two waivers on file for electronic sign in/ out and to share the playground with the Kindergarten program. The Director provided a copy fo the fire drill record, sign in and out records and the children's roster to the LPA. LPA reviewed 10 children's files. Each child's file reviewed contains the required information. LPA reviewed 5 staff files and found that all have completed the required Mandated Reporter Training (AB1207) and the required immunization's against Pertussis, Measles, and Influenza (or opt out letter). There is at least one teaching staff member that has current CPR and First Aid certifications on file. Ms. Jackson 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 (field trips). There were 20 preschool children present during today’s inspection. However, Ms. Jackson understands the conditions, limitations, and capacity specifications of the Facility license. Ms. Jackson understands that children shall be visually supervised at all times. A review of staff records today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 08/09/2022):

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MARSHALL LANE PRESCHOOL	FACILITY NUMBER: 434408734
	VISIT DATE: 08/09/2022

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/09/2022):
LPA reminded the Director of 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12-month period.
LPA observed that the room is clean and safe for all children and staff. Ms. Jackson states that the schools custodial team cleans the preschool rooms Monday through Friday in the evenings during the school year. Drinking water is readily available for the children inside via two water fountains and outside via personal water bottles. LPA observed solid waste containers with tight-fitting lids in the classrooms. Children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Ms. Jackson states that there are no weapons or firearms on the premises.
The Preschool provides AM and PM snacks and though most of the children bring their lunch from home, the school does offer a hot lunch, from the on site school cafeteria, upon request by the parent. The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. Cleaning supplies are inaccessible to the children and stored in locked cabinets inaccessible to children. Any medications at the Facility are stored in the Directors office. LPA observed a Fire Drill log with the last fire drill being conducted on 7/29/2022.
LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. The resilient materials (wood chips) in the outdoor playground area are low and not sufficient. LPA did not observe any bodies of water.
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regard to new regulations. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list childcareadvocatesprogram@dss.ca.gov. LPA discussed Assembly Bill (AB) 2370 and gave Lead Safety information.
LPA obtained a Facility roster and conducted an exit review with Ms Jackson.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: MARSHALL LANE PRESCHOOL	FACILITY NUMBER: 434408734
	VISIT DATE: 08/09/2022

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/09/2022):

The facility has an IMS program on record is currently caring for children with medication needs. LPA inspected the Medications and IMS documentation.

Director had a current CPR / First Aid card that is scheduled to expires 8/2023.

LPS/s discussed the requirements of AB 633 with the Licensee/Director (provide name) and provided the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the Licensee/Director understands the requirements. Upon receipt, Licensee/Director (provide name) shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

LPA/s also discussed "zero tolerance" related regulations with the Licensee/Director, (provide name) and was advised of the assessment for an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, A copy of this report was discussed and left with the Licensee, Donna Jackson, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022

LIC809 (FAS) - (06/04)

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