434410630-1-14-2020-07-CC-DVIA-BKTQ5P-20200114105215

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410630
Report Date: 01/14/2020
Date Signed: 01/14/2020 10:52:20 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:	GO KIDS CLUB @ SAN MARTIN GWINN		FACILITY NUMBER:	434410630
ADMINISTRATOR:	LAURA BEHL		FACILITY TYPE:	850
ADDRESS:	13745 LLAGAS AVENUE		TELEPHONE:	(408) 843-9000
CITY:	SAN MARTIN	STATE: CA	ZIP CODE:	95046
CAPACITY:	24	CENSUS: 14	DATE:	01/14/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Laura Behl		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 Analyst (LPA), Deanna Villagrana, conducted an unannounced annual/random inspection to the Facility today. LPA met with Laura Behl, director, and explained the nature of today's visit to her. The Facility is licensed in room 1 at San Martin Gwinn school located in a portable on the south side of the school. The playground area of the Facility is located between room 1 and 2 of the portables. LPA toured the Facility both inside and outside for today's inspection. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law, Menus, and Activity Schedule. A review of staff records on 01/13/2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Laura 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period. LPA reviewed ten children's and three staff (one director, one teacher and one assistant) files during today's inspection. All staff and children's files were complete. Two staff have current CPR and First Aid certifications on file. All staff have immunization on file. Director and Teacher file contain the required transcripts/verification of experience. Laura understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips).

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

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: GO KIDS CLUB @ SAN MARTIN GWINN	FACILITY NUMBER: 434410630
	VISIT DATE: 01/14/2020

NARRATIVE

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LPA observed that the teacher/child ratio was in compliance during today's visit. LPA observed 14 preschool children with one teacher, one assistant and director. Laura understands the conditions, limitations, and capacity specifications of the Facility license. Laura understands that children shall be visually supervised at all times. LPA observed that room is clean and safe for all children and staff. Laura states that the Facility staff rotate cleaning and sanitizing toys. The facility is cleaned daily by and outside janitorial service. Drinking water is readily available for the children via water dispenser and plastic cups. LPA observed solid waste containers with tight-fitting lids in the Facility. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff toilet not utilized by the children. Laura states that there are no weapons or firearms on the premises.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children. Any poisons are stored in locked storage cabinets in the kitchen and staff bathroom. Any medications at the Facility are stored in the kitchen in top cabinet secured in a metal box. No IMS is administered by the Facility.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. The building overhang provide shade for the day care children. LPA did not observe any bodies of water.

LPA conducted an exit interview with the Laura prior to the conclusion of today's visit and referred Laura to the Department website: www.ccld.ca.gov for additional information. Licensing Forms, Title 22 Regulations, and information can be obtained through the internet at www.cdss.ca.gov.

No deficiencies were cited during visit.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FACILITY ENTRANCE, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020

LIC809 (FAS) - (06/04)

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