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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413101
Report Date: 08/30/2019
Date Signed: 09/09/2019 12:56:35 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. LUCY SCHOOL PRE-KINDERGARTENFACILITY NUMBER:
434413101
ADMINISTRATOR:NICOLE QUINNFACILITY TYPE:
850
ADDRESS:76 KENNEDY AVENUETELEPHONE:
(408) 871-8023
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:24CENSUS: 12DATE:
08/30/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Nicole QuinnTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA), Stephanie Rangel, arrived at the facility on 8/30/19 to conduct an annual random inspection but, the Facility was closed. LPA returned on 9/9/19 and conducted an unannounced random inspection to the Facility today. LPA met with director Nicole Quinn and site supervisor Gina Kluge. LPA explained the nature of today's inspection to them. Days and hours of the Facility are Monday through 8:00am - 5:00pm. LPA toured the Facility both inside and outside during 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 (PUB 269), and Activity Schedule.

A review of staff records on 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 staff 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.

Sign in and out sheet reviewed. LPA reviewed 8 children's and 3 staff files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). Director and Site Supervisor have current CPR and First Aid certifications on file that expire 8/13/20. Director 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).

LPA observed that the teacher/child ratio was in compliance during today's inspection. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ST. LUCY SCHOOL PRE-KINDERGARTEN
FACILITY NUMBER: 434413101
VISIT DATE: 08/30/2019
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LPA observed that all rooms are clean and safe for all children and staff. Children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Director states that there are no weapons or firearms on the premises.

Cleaning supplies are stored on high shelves in the back sink area, away from children. Any medication(s) at the Facility will be in the back park that is hangs on the classroom wall. 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. Drinking water is readily available for the children in the Facility and in the outdoor playground area via water fountain and personal water bottles. LPA observed that the outdoor toys are age appropriate and in good condition. There is sufficient resilient materials in the outdoor playground area. LPA did not observe any bodies of water.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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

No Deficiencies cited today. Appeal rights printed and reviewed.

Effect of Lead Exposure handout dated 1/20/19 given during today’s inspection. Licensee understands that per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians. LPA reminded Licensee of the Immunization Regulations for Senate Bill (SB) 792. LPA reminded the licensee that they can sign a declaration to be exempt from the influenza vaccinations however; Pertussis and Measles are not exemptible. LPA discussed the requirement to complete the California School Immunization Record (PM 286) for children's files.


Licensing Forms, Title 22 Regulations and information can be obtained through the internet at www.ccld.ca.gov.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2019
LIC809 (FAS) - (06/04)
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