434410800-8-19-2019-52-CC-MMEA-BF7QYN-20190819123526

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410800
Report Date: 08/19/2019
Date Signed: 08/19/2019 12:35:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	MVWSD PRESCHOOL AT THEUERKAUF		FACILITY NUMBER:	434410800
ADMINISTRATOR:	KIMBERLY BARILLAS		FACILITY TYPE:	850
ADDRESS:	1625 SAN LUIS AVENUE		TELEPHONE:	(650) 526-3500
CITY:	MOUNTAIN VIEW	STATE: CA	ZIP CODE:	94043
CAPACITY:	48	CENSUS:	DATE:	08/19/2019
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Terri Kemper		TIME COMPLETED:	12:45 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	A Case Management Visit was conducted on this date 8/19/19 by Licensing Program Analysts (LPAs), Mayla Mendoza and Paul Petersen. LPAs met with Director of Preschool, Terri Kemper (previously Wallace-Bielecki). Program is located within Theuerkauf Elementary School. The center has submitted an application for an increase in capacity from 48 to 64 children. Room 25 is also being added to the center license. The center will now be operating in 3 classrooms (Rooms 23, 24 & 25). Hours of operation are from 8:00am-3:00pm, Monday through Friday. The program serves a full and a half day program. The half day program runs from 8-11am, and 12-3pm, Monday through Friday. A health and safety inspection was conducted inside and outside. The following are the measurements: INDOORS: 2641.947 square feet = 75 children OUTDOORS: 7429.62 square feet = 99 children Openers and closes have current CPR/FA. Playground equipment is in good condition. Drinking water is available inside and outside by way of water fountains, water jugs and water bottles. A yard waiver is already in place for shared outdoor play with the TK/Kindergarten program. All toilets and handwashing facilities are in safe and sanitary operating conditions. Menus are posted. Breakfast, lunch and snacks are provided and prepared on site. There is adequate variety and quantity of foods to meet the children's needs. The storage of napping equipment was observed. The sign in and out logs were reviewed. Facility has a functioning carbon monoxide detector. This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2019

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MVWSD PRESCHOOL AT THEUERKAUF	FACILITY NUMBER: 434410800
	VISIT DATE: 08/19/2019

NARRATIVE

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A review of staff records on 8/19/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The center has obtained an approved fire safety inspection from the City of Mountain View Fire Department on 8/14/19. All licensing required documents are posted.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

Zero Tolerance policies were explained. Notice of Site Visit form was provided and posted.
The center was found to be clean, safe, sanitary and in good repair. There are no deficiencies cited during this visit. A license for 64 preschool children will be issued effective today 8/19/19.

An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2019

LIC809 (FAS) - (06/04)

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