434410604-9-26-2019-07-CC-SYIP-BGDP26-20190926105525

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410604
Report Date: 09/26/2019
Date Signed: 09/26/2019 10:55:37 AM

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:	STATE PRESCHOOL AT SWANSTON		FACILITY NUMBER:	434410604
ADMINISTRATOR:	SUSAN ROLIN		FACILITY TYPE:	850
ADDRESS:	240 SWANSTON LANE		TELEPHONE:	(408) 847-7835
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	30	CENSUS: 21	DATE:	09/26/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Lupe Vela		TIME COMPLETED:	11:00 AM

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 Analysts (LPAs) Samantha Yip and Nancy Rodriguez conducted an unannounced annual random inspection. LPA met with Lupe Vela, Preschool Coordinator, and explained the reason for the inspection. Present during the inspection were 21 children and 3 staff. The child staff ratio was observed to be in compliance during today's inspection. Facility is located in Rainbow Room. The hours of operation are Monday through Friday 8:30 to 11:30AM and 12PM to 3PM LPA reviewed the sign in/out sheet. License, Notification of Parent's Rights, and Emergency Disaster Plan were observed to be posted. LPAs toured in the inside and outside of the facility with Preschool Coordinator. The facility was observed to be clean and sanitary. LPAs observed that there was a spray bottle with bleach in cabinet in the children's restroom. Ms. Lupe placed spray bottle in a higher cabinet, which is inaccessible to children. LPA reminded Preschool Coordinator that all disinfectants and cleaning supplies, such as spray bottle of bleach, should be stored inaccessible to children in care. The furniture and the equipment, such as tables and chair were age-appropriate and in good condition; free of sharp or loose, or pointed parts. The floors were clean and free of tripping hazard. LPA observed there is sufficient amount of age-appropriate toys for children in care. Restrooms for children’s use were observed to be safe, sanitary, and in functioning condition. Storage containers for waste have tight fitted lids. Ms. Lupe stated that there are no weapons stored on the premise. LPAs observed a fully charged fire extinguisher, functioning carbon monoxide detector, and smoke detector. -----------------------continues on 809 dated 09/26/2019 page 2-------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019

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: STATE PRESCHOOL AT SWANSTON	FACILITY NUMBER: 434410604
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/26/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/03/2019 Section Cited	1 2 3 4 5 6 7	Building and Grounds. Disinfectants, cleaning solutions, poisons, and other dangerous items shall be inaccessible to children. This requirement is not met as evident by:
	8 9 10 11 12 13 14	Based on observation, LPA observed there was a spray bottle with bleach in cabinet in children's bathroom, which was accessible to children in care. This poses a potential risk to the health and safety to the children in care.	8 9 10 11 12 13 14
Type B 10/03/2019 Section Cited	1 2 3 4 5 6 7	Fixtures, Furniture, Equipment and Supplies. Equipment shall be maintained in a safe condition, free of sharp, loose or pointed parts. This requirement is not met as evident by:
	8 9 10 11 12 13 14	Based on observation, LPA observed that there was a crack on one of the play equipment outside. There was also a play structure, which was is starting to rot on the bottom and a screw was protruding. This poses a potential risk to the children in care.	8 9 10 11 12 13 14

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) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019

LIC809 (FAS) - (06/04)

Page: 4 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: STATE PRESCHOOL AT SWANSTON	FACILITY NUMBER: 434410604
	VISIT DATE: 09/26/2019

NARRATIVE

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-----------------continuation of 809 dated 09/26/2019 page 2-------------------------------------

Ms. Lupe stated that she currently does not have any children in care who requires Incidental Medical Services (IMS) services. Plan for Providing IMS is on file. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

Ms. Lupe is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

In the areas evaluated during today's inspection, two Type B citations have been cited. An exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were discussed with Ms. Lupe, Preschool Coordinator.

A NOTICE OF SITE VISIT WAS ISSUE AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019

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: STATE PRESCHOOL AT SWANSTON	FACILITY NUMBER: 434410604
	VISIT DATE: 09/26/2019

NARRATIVE

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----------------------continuation of 809 dated 09/26/2019 page 1----------------------------------

The outdoor activity area is fenced. Areas around play structures were cushioned with resilient materials to absorbs falls. Shaded rest areas are provided through trees and building overhang. LPA did not observe any bodies of water. LPAs did observe that one of the play equipment has a crack, which is starting to get sharp. Ms. Lupe placed duct tape over crack. LPA also observed that the wood at the bottom of the play house is starting to rot. LPA also observed that they were was a screw that was protruding on the bottom. Ms. Lupe had maintenance remove the screw during inspection. Ms. Lupe stated that they are having someone from the district come to decide if they are going to repair the play house or to remove it. LPA discussed with Ms. Lupe about having staff sweep the playground for equipment that needs to be repaired or thrown out.

Facility does provides snacks to the children in care. Menu was observed to posted. All snacks are prepared through Gilroy School District and brought to the facility. There is a kitchen to store snacks. Kitchen was observed to be clean and sanitary. Drinking water is provided through water fountains.

10 children’s files were reviewed during today’s inspection. The records reviewed include not limited to admission agreement.

3 staff files were also taken for review. The records reviewed include but not limited to education credit and CPR/1st Aid. All staff present have a valid CPR/1st Aid, which expires on 10/12/2020. Passports for Teachers were completed.

Facility is a State Preschool; therefore, the Gilroy School Disrtrict monitors all criminal record and child abuse index clearance. Ms. Lupe verified that all staff are fingerprint cleared.

----------------continues on 809 dated 09/26/2019 page 3-----------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019

LIC809 (FAS) - (06/04)

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