434410800-8-29-2022-52-CC-SDOO-CHRTGR-20220829144335

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410800
Report Date: 08/29/2022
Date Signed: 08/29/2022 02:43:52 PM

Document Has Been Signed on 08/29/2022 02:43 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	MVWSD PRESCHOOL AT THEUERKAUF		FACILITY NUMBER:	434410800
ADMINISTRATOR:	TERRI KEMPER		FACILITY TYPE:	850
ADDRESS:	1625 SAN LUIS AVENUE		TELEPHONE:	(650) 526-3560
CITY:	MOUNTAIN VIEW	STATE: CA	ZIP CODE:	94043
CAPACITY:	64	CENSUS: 25	DATE:	08/29/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Terri Kemper		TIME COMPLETED:	02:45 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	On Monday 8/29/2022 at approximately 12:30PM, Licensing Program Analyst (LPA) Sabina Dodoo met with Director Terri Kemper for an UNANNOUNCED ANNUAL REQUIRED INSPECTION for Barack & Michelle Obama Preschool at Theuerkauf. Present for the inspection was the Director and five teachers who are all fingerprint cleared. The total children enrolled are 33 and the census was 25 children at the time of the inspection. The Child Care Center is within ratio. The Child Care Center is opened Monday through Friday from 8am to 3pm. This Pre-school is a Title 5 Pre-school under the Mountain View Whisman School District. The Child Care Center was toured to conduct a Health and Safety Inspection. PHYSICAL PLANT: The entrance of the school is a gate that leads to the preschool. The school is located on the same campus as Theuerkauf Elementary School. The parents sign in and out on paper on a sign in sheet at the entrance of the classroom. There are three classrooms. The classrooms have cubbies with children’s names on them where personal items can be placed. There are at least two bathrooms with toilets in operable conditions in each classroom. The isolation area is in the main Elementary School Office. LPA observed children sleeping on sleeping mats during nap time. LPA observed the bulletin board (parent’s rights, emergency disaster plan, earthquake drills and facility license). All hazardous materials and toxins are kept out of reach from children and are not accessible. There is a fully charged fire extinguisher 3A 10 40 BC in each classroom. There is one working carbon monoxide detector, one working smoke detector, a telephone and a fully stocked first aid kit in the classrooms. The furniture around the classrooms and outdoor area are all child proof and adequate for children to use. The learning materials are organized, and toys are kept in safety bins and cabinets for easy access for the children.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

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 3

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: 08/29/2022

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
26
27
28
29
30
31
32

FOOD & SNACK: The school provides breakfast and lunch for the children. The food is provided by the school district. Children bring personal water bottles from home and the teacher refills the bottles as necessary. LPA observed the menu posted on the parent board in the classroom.
OUTDOOR: LPA Dodoo observed the outdoor area which consist of a play structure with slides and a sandbox. There is tan bark material all around the play structure to absorb falls. The outdoor play area is also fenced all around with secured gates. There are no bodies of water on the premises. There are no firearms on premises.

RECORDS: LPA reviewed 5 children’s files and 6 staff files(Director included) and documented them on LIC 859 and LIC 857. An updated roster was viewed by LPA. A copy was provided to LPA by Director. The staff interview was completed with Director Terri Kemper. Director and staff have completed the Health and Safety training and CPR/First Aid is current. The Director and Staff are following the immunization laws and have completed the mandated reporter training. The Director has conducted and documented the fire and disaster drills twice a year. The last conducted drill was on August 29^th 2022. All required forms are posted and visible for public view.

Incidental Medical Services (IMS) policy was discussed. This facility is providing IMS (Incidental Medical Services) to children currently in care. LPA Dodoo observed medications that had unaltered labels and are unexpired. If any IMS is provided, a Plan for Providing 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

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 08/29/2022

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
26
27
28
29
30
31
32

Director was reminded that all adults 18 and over working in Child Care Center, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Director was reminded of the responsibility as a mandated reporter and the trainings must be done once every two years as well as CPR/First Aid needs to be renewed every two years and must be EMSA approved. LPA also encouraged licensee to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, as well as all forms can be downloaded. For licensing updates and Quarterly Child Care Distribution email, email childcareadvocatesprogram@dss.ca.gov and ask to be added to the email list.

Effective August 1, 2003 California Law requires Child Care licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624 within 7 business days.

There are no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days. A copy of Appeals rights was provided. Exit Interview and staff interview was conducted with Director(Terri Kemper). This report shall remain on file for the next 3 years.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3