434410604-9-14-2022-07-CC-SYIP-CJA2EF-20220914171951

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410604
Report Date: 09/14/2022
Date Signed: 09/14/2022 05:19:57 PM

Document Has Been Signed on 09/14/2022 05:19 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
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: 18	DATE:	09/14/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:12 AM
MET WITH:	Beatrice Magdaleno		TIME COMPLETED:	01:15 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 Coordinator, and Beatrice Magdaleno, Early Childhood Administrator, and explained the reason for the inspection. Present during today's inspection were 18 children and at least 3 staff. There is an area to post required posting, such as license, emergency disaster plan, notification of parent's rights, and car seat law. The hours of operation are Monday through Friday 8:15AM to 11:15AM and 12PM to 3PM. There is working phone on the premises. LPA toured in the inside and outside of the facility with Beatrice. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible. Toys and equipment were observed to be in good condition. Floors were free of tripping hazard. There is a fully charged fire extinguisher and smoke detector. Beatrice stated that they need to confirm that detector is a combo carbon monoxide and smoke detector. Beatrice stated that she will follow-up with Licensing once their maintenance confirms. Beatrice stated that there are no weapons, such as firearms, stored on the premise. The outdoor area is fenced. Area around play structure has resilient material. Shaded rest area is provided through trees, building overhang, and canopy. There was no bodies of water observed during today's inspection. ------------------continues on 809 dated 09/14/2022 page 1------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: STATE PRESCHOOL AT SWANSTON	FACILITY NUMBER: 434410604
	VISIT DATE: 09/14/2022

NARRATIVE

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--------------------continuation of 809 dated 09/14/2022 page 1------------------
All meals are prepared at the Gilroy Unified School District Middle School, then brought to the facility. There is a kitchen to store and prepare meals. Sink has hot running water. Drinking water is provided through water fountains and water cooler and cups. Menu was observed to be posted.

Facility does not currently provide Incidental Medical Services. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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

A copy of the facility roster was obtained. 10 children's files were reviewed during today's inspection. The records reviewed include but not limited to physician's report and parent's rights. LPA reminded Beatrice to ensure that the parent's rights are filled out completely.

Four (4) staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit, Mandated Reporter training, and immunization records. All staff completed Mandated Reporter training 08/2022. All staff have a valid CPR/1st Aid, which expires on 10/2023. LPA reminded Beatrice to obtain an updated proof of influenza or a decline of influenza statement and place it in their file. LPA discussed with Beatrice about Site Supervisor and submitting paperwork for site supervisor. LPA provided Beatrice with an updated list of documents that need to be submit for new site supervisors.

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

As a result of this inspection, one technical violation was issued. Exit interview conducted and report was reviewed with Early Childhood Administrator, Beatrice Magdaleno. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022

LIC809 (FAS) - (06/04)

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