434410766-2-28-2020-07-CC-DVIA-BM8RXC-20200228122431

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410766
Report Date: 02/28/2020
Date Signed: 02/28/2020 12:24:37 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:	ST JUSTIN PRESCHOOL		FACILITY NUMBER:	434410766
ADMINISTRATOR:	SHANNON BARELA		FACILITY TYPE:	850
ADDRESS:	2655 HOMESTEAD ROAD		TELEPHONE:	(408) 248-1094
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	51	CENSUS: 39	DATE:	02/28/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Shannon Barela		TIME COMPLETED:	12:35 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), Deanna Villagrana, conducted an unannounced one year required visit to the Facility today. LPA met with Shannon Barela, director, and explained the nature of today's visit to her. The Facility is licensed in room 1 and 5. The playground area of the Facility is located on the side of the classrooms. The Facility has two active waivers to share playground and bathroom with primary age children. LPA reminded Shannon that the preschool children and primary children cannot commingle, either inside the Facility or in the playground area of the Facility, outside the times of the approved waivers. 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, and Activity Schedule. A review of staff records on 02/25/2020 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 Shannon 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 six staff (1 director, 4 teachers and 2 aides) files during today's inspection. All staff and children's files were complete. Three staff have current CPR and First Aid certifications on file. Director and teachers files reviewed contain the required transcripts/verification of experience, completed Mandated Reporter Training and immunizations. Shannon 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: 02/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020

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: ST JUSTIN PRESCHOOL	FACILITY NUMBER: 434410766
	VISIT DATE: 02/28/2020

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LPA observed that the teacher/child ratio was in compliance during today's visit. LPA observed 17 preschool children with director, one teacher and one aide in room 1 and 22 preschool children with two teachers and one aide in room 5. Shannon understands the conditions, limitations, and capacity specifications of the Facility license and understands that children shall be visually supervised at all times. LPA observed that both rooms are clean and safe for all children and staff. Shannon states that a janitor cleans the facility daily. Drinking water is readily available for the children in each room and in the outdoor playground area water fountain. LPA observed solid waste containers with tight-fitting lids in the Facility. Children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children. Shannon states that there are no weapons or firearms on the premises.

Children are required to bring snack and lunch from home. Shannon states a plan is made when children forget their snacks or lunch and has snacks available for children if needed. Cleaning supplies are inaccessible to the children and stored in high cabinets. Any medications at the Facility are stored in a locked cabinet in room 1. IMS is being administered by the Facility for one child. LPA observed forms are complete and medication is not expired.

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. Several trees provide shade for the day care children. LPA did not observe any bodies of water.

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

No deficiency was 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: 02/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020

LIC809 (FAS) - (06/04)

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