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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410620
Report Date: 10/15/2019
Date Signed: 10/15/2019 12:56:38 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:LITTLE TREE PLAYSCHOOL, THEFACILITY NUMBER:
434410620
ADMINISTRATOR:WRIGHT, RACHELEFACILITY TYPE:
850
ADDRESS:7275 SANTA TERESA BLVD.TELEPHONE:
(408) 972-9200
CITY:SAN JOSESTATE: CAZIP CODE:
95139
CAPACITY:30CENSUS: 11DATE:
10/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:21 AM
MET WITH:Wright, RacheleTIME COMPLETED:
01:12 PM
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An unannounced Annual Random Inspection was conducted on this day by Licensing Program Analyst (LPA) Almaraz, Araceli. Facility is currently licensed for a capacity of 30. Licensing staff met with Director Wright, Rachele. The program currently operates 7 AM to 6 PM, Monday thru Friday. Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. At the initial start of the site visit, there is a total census of 11 children all preschoolers, and a total staff of two, one teacher, one teachers assistant.

Physical Plant:
Preschool Room: The following was observed of this room during the inspection of the facility: Upon arrival, this room had 2 staff with 11 preschoolers; One teacher and one teachers assistant. Furniture and equipment were inspected for age appropriateness and are in sufficient condition. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubicle to store their belongings. Per Director Wright, the isolation area is in the office. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Disinfectants, cleaning solutions, medication and other hazardous items that pose a risk to children, were inaccessible to the children in care. Director Wright states that poisons are locked in the staff bathroom closet. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition. Director Wright states waste is to be discarded immediately after each meal. First Aid supplies were observed in the classroom in pouches. According to Director Wright, medication is only administered to a child when accompanied with a doctor's note and is stored in the office. Carbon monoxide detectors and smoke detectors are working presently in the facility. There are two Fire extinguishers size 2A10BC in this room and have been serviced on 10/30/2018. Teacher and child ratios were observed and staff names recorded. There are 7 tables with 4 chairs per table, all age appropriate. LPA Almaraz concludes, this room is currently in compliance with licensing standards. *****Page 1/5, Report Continued on Page 2*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
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: LITTLE TREE PLAYSCHOOL, THE
FACILITY NUMBER: 434410620
VISIT DATE: 10/15/2019
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

The following was discussed with the Director:
Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. No infant walkers, no Johnny Jumpers, no excersaucers or any other item that falls into that category are allowed in facility.

The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA discussed Safe Sleep Awareness Campaign during today’s inspection.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

*****Page 4/5, Report Coninuted on Page 5*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: LITTLE TREE PLAYSCHOOL, THE
FACILITY NUMBER: 434410620
VISIT DATE: 10/15/2019
NARRATIVE
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LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check.

LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.

The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised to visit www.shotsforschool.org for immunization information.

Director advised that indoor and outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.

These forms may also be downloaded from our website: www.ccld.ca.gov

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1. Exit interview conducted and copy of report was given.

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

*****Page 5/5, Final Page of Report*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5
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: LITTLE TREE PLAYSCHOOL, THE
FACILITY NUMBER: 434410620
VISIT DATE: 10/15/2019
NARRATIVE
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All lavatories have appropriate water temperature, sufficient toilet paper, area safety and sanitation. LPA Almaraz observed soap dispenser and disposable towels. LPA Almaraz concludes, lavatory and all toilets/commodes and sink/washbasins are currently in compliance with licensing standards. LPA Almaraz observed this area is in compliance with licensing waiver. Age appropriate sinks and toilets/commodes were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation.

Playground: The following was observed of the playground: Outdoor equipment was inspected for safety, cushioning material, good repair and appropriateness. Required shade, drinking water and fencing were inspected. LPA Almaraz advised that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. The children have access to drinking water during outside play. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed. There are three chickens in a chicken coop in this area. There is a waiver on file for shared playground of preschool, toddler and infant programs. The waiver states usage of the play area may not occur at the same time. Director Wright states there is no one enrolled in toddler program currently and infants do not use this area. Director Wright states supervision and schedule differentials acts as a deterrent from commingling when playground is used by all programs. There is a waiver on file for commingling of this area from 7 AM-8 AM and 5 PM-6 PM, Monday thru Friday. Director Wright states there is no one enrolled in toddler program currently and infants do not use this area. LPA Almaraz observed facility is currently in compliance with both waivers noted in this paragraph. LPA Almaraz concludes play ground is currently in compliance with licensing standards.



Records:
Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed, facility currently uses an electronic system. Personal Rights of children were observed by LPA Almaraz. Last fire/earthquake/disaster drill logged 09/11/2019.

Directors records were reviewed. Criminal Record Clearances were reviewed for adults. CPR card expires on 08/15/2020. Mandated Abuse Reporter Training taken on 08/23/2018. Director Wright understands training is to be completed every two years. All records of education verified and immunization's checked for required documents. Director Wright has written statement opting out of flu vaccine.*****Page 3/5, Report Continued on Page 4*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
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: LITTLE TREE PLAYSCHOOL, THE
FACILITY NUMBER: 434410620
VISIT DATE: 10/15/2019
NARRATIVE
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Toddler room: The following was observed of this room during the inspection of the facility: Upon arrival, this room had 0 staff with 0 preschoolers/toddlers; Furniture and equipment were inspected for age appropriateness and are in sufficient condition. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubicle to store their belongings. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Disinfectants, cleaning solutions, medication and other hazardous items that pose a risk to children, were inaccessible to the children in care. Director Wright states that poisons are locked in the staff bathroom closet. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition. Director Wright states waste is to be discarded immediately after each meal. First Aid supplies were observed in the classroom in pouches. Carbon monoxide detectors and smoke detectors are working presently in the facility. There is one Fire extinguisher size 2A10BC in this room and has been serviced on 10/30/2018. There is one table with 8 chairs per table, all age appropriate. This room has one sink and one refrigerator. LPA Almaraz concludes, this room is currently in compliance with licensing standards

Kitchen: There is a separate kitchen area, common area for preschool, toddler option and infant program. This area/food preparation area and food storage area is kept clean and are free of litter, and rubbish. There is one sink and one refrigerator in this area. LPA observed this area is currently in compliance with licensing standards. All storage containers in this area for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition.

Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Quarterly menus are available upon request. Lunch is served daily. Children have an option to bring own food or receive hot lunch.



Lavatories:
The following was observed of the lavatories during the inspection of the facility: There is one lavatory beside the kitchen area. There is waiver on file for a shared bathroom. Director Wright states the lavatory is shared between preschool children and the toddler option program. Director states that at no point is there commingling or is the lavatory used at the same time. Director Wright states supervision and schedule differentials acts as a deterrent from commingling. LPA observed lavatory including the sinks and commodes are accessible. There are two commodes and two sinks. *****Page 2/5, Report Continued on Page 3 *****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5