434410604-9-22-2021-07-CC-SYIP-C74QQE-20210922122214

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410604
Report Date: 09/22/2021
Date Signed: 09/22/2021 12:22:20 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:	STATE PRESCHOOL AT SWANSTON		FACILITY NUMBER:	434410604
ADMINISTRATOR:	SUSAN ROLIN		FACILITY TYPE:	850
ADDRESS:	240 SWANSTON LANE		TELEPHONE:	(669) 205-7960
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	30	CENSUS: 9	DATE:	09/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:28 AM
MET WITH:	Lupe Vela		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) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Lupe Vela, Preschool Office Coordinator, and explained the reason for the inspection. Present during today's inspection were at 3 staff, whom 2 was fully qualified, and 9 children. Facility was within ration during today's inspection. There is a board to post required posting. LPA also observed that COVID posters are posted. There is working phone at the facility. The hours of operation are Monday through Friday 8:15AM- 11:15AM and 12PM -3PM. LPA toured the inside and outside of the facility with Lupe Vela. The facility was observed to be clean. All disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible. LPA observed a bottle of Clorax wipes on the shelf. Lupe moved Clorax wipes to a cabinet that was inaccessible to children. LPA reminded Lupe that any disinfectant wipes need to be inaccessible to children. There is sufficient amount of toys for children. Furniture and equipment were observed to be in good condition. Bathroom for children were observed to be clean. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Lupe stated that there are no weapons, such as firearms, stored in the facility. The outdoor area is fenced. Area around the play structure have resilient material to absorb falls. Shaded rest area is provided through canopy. LPA observed that one of the play equipment is starting to crack on the top, which was not sharp. Lupe stated that she will place a work order for the play equipment and to ensure that wooden shed outside does not have any sharp edges. There were no bodies of water observed during today's inspection. --------------------CONTINUES ON 809 DATED 09/22/2021 PAGE 2-------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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: STATE PRESCHOOL AT SWANSTON	FACILITY NUMBER: 434410604
	VISIT DATE: 09/22/2021

NARRATIVE

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-----------------------CONTINUATION OF 809 DATED 09/22/2021 PAGE 1-----------------------

Facility does provide meals and snacks to the children. All meals and snacks are prepared by Gilroy Unified School District. There is kitchen to store food. Drinking water is provided through water cooler and cups.

Facility does provide Incidental Medical Services (IMS). Medication was observed to be stored inaccessible to children. Medication was in the original packaging with parent consent and physician instruction.

9 children's file were reviewed during today's inspection. The records reviewed include but not limited to Emergency Contact Card and parent's rights. LPA reminded Lupe to check that forms are filled out and signed. LPA observed that C-1 did not have the top portion filled out for the LIC 627: Consent for Emergency Medical Treatment. Lupe stated that she will send proof that forms were filled out to Licensing.

4 staff files were reviewed during today's inspection. The records reviewed include health screening, Mandated Reporter Training, and immunization records for measles, pertussis, and influenza. LPA reminded Lupe to place copy of Mandated Reporter Training and proof of influenza in file. LPA observed that S-1 did not have Mandated Reporter Training in file. Lupe stated that she will send certificate to Licensing. There is at least one staff on site with a valid CPR/1st Aid, which expires on 11/01/2021. Lupe informed LPA that they are changing director. LPA provided list of forms that need to be submitted during today's inspection.

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

In the areas evaluated during today's inspection, no deficiencies were cited as a result of this inspection. A exit interview was conducted where this report was discussed and provided to Lupe Vela, Preschool Office Coordinator. A Notice of Site Visit has been issued 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: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC809 (FAS) - (06/04)

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