434408879-12-3-2019-07-CC-PHEZ-BJJ2DZ-20191203161909

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408879
Report Date: 12/03/2019
Date Signed: 12/03/2019 04:19:18 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:	ST. LEO THE GREAT - LITTLE LIONS PRESCHOOL		FACILITY NUMBER:	434408879
ADMINISTRATOR:	LYNNE STASI		FACILITY TYPE:	850
ADDRESS:	1051 WEST SAN FERNANDO STREET		TELEPHONE:	(408) 293-3473
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY:	24	CENSUS: 18	DATE:	12/03/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Lynne Stasi		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	On 12/03/19 Licensing Program Analysts (LPAs) Monica Mathur and Pietro Hernandez conducted an unannounced Annual/Random inspection of St. Leo The Great - Little Lions Preschool today. The preschool is located on the premises of St. Leo The Great Elementary Catholic School. LPAs met with Director, Lynne Stasi and explained the purpose of today's visit. Facility’s License, Parents’ Rights Poster PUB393, Personal Rights, and Activity Schedules, were observed to be posted. Facility's operating days and hours are Monday to Friday 7:30 AM to 6:00 PM. There is an active waiver on file for: Shared Outdoor Space The physical plant was inspected. LPA toured the building with the Director. Indoor space: The classroom, restrooms and office area were inspected. LPAs observed 18 children with 2 teachers and Director present during inspection. Facility was in compliance with teacher to children ratio requirement. Children were engaged in various activities under the visual supervision of the teachers. LPAs did not observe disinfectants, cleaning solutions or chemicals that are dangerous to the health and safety of children. All other cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair. Director stated that facility does not possess nor store any weapons on the premises. LPA observed a 3A40BC Fire extinguisher, working Smoke and Carbon Monoxide Detectors, fire pull stations, and sprinkler system. Log shows that the last Fire Drill was conducted on 9/30/19. Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019

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: ST. LEO THE GREAT - LITTLE LIONS PRESCHOOL	FACILITY NUMBER: 434408879
	VISIT DATE: 12/03/2019

NARRATIVE

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LPA provided a lead safety brochure to the licensee.

Deficiency was cited on the 809-D page of the report. This report was reviewed with the Director.

Website for provider resources:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates

childcareadvocatesprogram@dss.ca.gov

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019

LIC809 (FAS) - (06/04)

Page: 3 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: ST. LEO THE GREAT - LITTLE LIONS PRESCHOOL	FACILITY NUMBER: 434408879
	VISIT DATE: 12/03/2019

NARRATIVE

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Outdoor Space: Outdoor playground was inspected and observed to be safe. The play equipment was maintained in good condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.

File Review: Children sign in and out procedures and logs were reviewed. A sampling of 8 Children's files and 1 Staff file was taken for review. One staff identified as S1 did not have any licensing forms and documents on file. All child files contained immunization's, Physician's and Parent's Health Report. Staff files contained appropriate educational units. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. Children's Roster was reviewed.

Director stated that facility does handle medications and currently do not have children in care who require Incidental Medical Services. Facility has an approved IMS Plan on file with San Jose Regional Office. LPA reviewed storage of medication and equipment / supplies. Isolation of sick child was discussed, and Director explained that a sick child is brought to the office area to be isolated from other children. A child's restroom, inside the gym, is used and is off limits to other children is located next to the office is used if necessary. Child is always under visual supervision while being cared for.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she currently does not have any children in care who requires IMS. 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) & link to Commonly Asked Questions and the ADA, available at:<http://www.ada.gov/childqanda.htm> .

LPA reminded Director 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. For an initial violation, civil penalty amounts to $100.00 per person per day with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person. LPA also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019

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: ST. LEO THE GREAT - LITTLE LIONS PRESCHOOL	FACILITY NUMBER: 434408879
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/03/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/17/2019 Section Cited	1 2 3 4 5 6 7	Personnel Records: All staff files require to have licensing forms and documents. This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Per LPA's review of staff files, S1 does not have required licensing forms and documents.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019

LIC809 (FAS) - (06/04)

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