434412013-5-18-2023-07-CC-SYIP-CRXKTW-20230518081146

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412013
Report Date: 05/17/2023
Date Signed: 05/18/2023 08:11:58 AM

Document Has Been Signed on 05/18/2023 08:11 AM - 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GILROY UNIFIED SCHOOL DISTRICT ROD KELLEY PRE.		FACILITY NUMBER:	434412013
ADMINISTRATOR:	GAYLE DARR		FACILITY TYPE:	850
ADDRESS:	8755 KERN AVENUE		TELEPHONE:	(669) 205-4700
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	24	CENSUS: 17	DATE:	05/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Gayle Darr and Lupe Vela		TIME COMPLETED:	12:40 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) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Director Gayle Darr and explained the reason for the inspection. Preschool Coordinator, Lupe Vela, arrived shortly after. The center is located on the Rod Kelley Elementary School campus. Present during today's inspection were 17 children and at least four (4) staff. There is an area to post required postings, such as license, notification of parent's rights, and car seat law. The hours of operation are Monday through Friday 8:15AM to 11:15AM and 12:00PM to 3:00PM. LPA toured the inside and outside of the facility. LPA observed that there was a bottle of disinfectant spray on top of the paper towel dispenser in the children restroom. LPA discussed with Preschool Coordinator about ensuring that disinfectant sprays are inaccessible to children. All other disinfectant, cleaning supplies, or other items that could pose a risk to children were observed to be inaccessible to children. There are toys and equipment for children. The floors were clean and free of tripping hazard. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted on 04/21/2023. There are no weapons, such as firearms, stored on the premise. The outdoor activity space is fenced. LPA discussed with Preschool Coordinator that the fence is closed at all time. Area around play structure has resilient material. Shaded rest area is provided through trees and building overhang. There were no bodies of water observed during today's inspection. -----------------------continues on 809 dated 05/17/2023 page 2--------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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: GILROY UNIFIED SCHOOL DISTRICT ROD KELLEY PRE.	FACILITY NUMBER: 434412013
	VISIT DATE: 05/17/2023

NARRATIVE

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-------------------continuation of 809 dated 05/17/2023 page 1---------------------

All meals and snacks are prepared at the elementary school. Menu was observed to be posted. Drinking water is provided through individual water bottles or bottle water.

The center currently does not have any children who require Incidental Medical Services (IMS). For IMS information, see PIN 22-02-CCP. 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

Five (5) children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and immunization records.

Three (3) staff files were also reviewed. The record reviewed include but not limited to education credit and immunization records.

Facility is a State Preschool; therefore, the Gilroy School District monitors all criminal record and child abuse index clearance. Preschool Coordinator verified that all staff are fingerprint cleared.

Facility will submit the following by 05/19/2023:
- self certification that the center does not use drinking fountain
- facility roster
- Immunization records and mandated reporter training certificate for S-2

Facility will submit immunization records for S-1 as soon as she obtains immunization records.

No deficiencies were issued as a result of this inspection. Exit interview conducted and report was reviewed with Preschool Coordinator, Lupe Vela. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC809 (FAS) - (06/04)

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