<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413114
Report Date: 12/04/2019
Date Signed: 12/04/2019 11:06:51 AM

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:WILLOWS NURSERY SCHOOL, THEFACILITY NUMBER:
434413114
ADMINISTRATOR:KLEEFELD, NATALIEFACILITY TYPE:
850
ADDRESS:1149 MINNESOTA AVENUETELEPHONE:
(408) 657-7529
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:17CENSUS: 14DATE:
12/04/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Natalie KleefeldTIME COMPLETED:
11:20 AM
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), Mel Matos, met with Natalie Kleefeld, director, for an unannounced annual/required 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), Menus, and Activity Schedule. The Facility has no waivers on file. Hours of operation: 8:30 AM to 1:30 PM Monday to Friday currently due to lack of demand for full day care. Normal hours of operation: 8:30 AM to 3:30 PM Monday to Friday. Natalie states that the Facility will be closed from December 13, 2019 to January 3, 2020 for the Christmas/New Year's holiday.

A review of staff records on December 3, 2019 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 Natalie 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 three (1 director and 2 teachers) staff files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). The director and all teacher files reviewed contain the required transcripts/verification of experience. LPA observed that all staff have completed the required Mandated Reporter training for Child Care Workers and have record of the required vaccines on file. LPA reminded Natalie that staff must retake the Mandated Reporter Training every two years. Natalie and two teachers has current CPR and First Aid certifications on file. Natalie understand 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).

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 12/04/2019):
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
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 2
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: WILLOWS NURSERY SCHOOL, THE
FACILITY NUMBER: 434413114
VISIT DATE: 12/04/2019
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
CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 12/04/2019):

LPA toured the Facility both inside and outside during today's inspection. LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA observed 2 teachers with 14 preschool children in the Facility during today's inspection. Natalie was not in ratio as she was assisting with snack preparation and also assisting children with potty breaks. Natalie understands the conditions, limitations, and capacity specifications of the Facility license. Natalie understands that children shall be visually supervised at all times; including when they go outside (fenced/gated front porch area) to put/take item(s) from the cubby area.

LPA observed that all rooms are clean and safe for all children and staff. The Facility has barricaded stairs indoors. Natalie states that the upstairs area is only used for staff office space, supply storage, and staff bathroom. Natalie states that the Facility staff clean the Facility Monday through Friday in the evenings. Drinking water is readily available for the children in each room and in the outdoor playground area via water dispensers /reusable cups. LPA observed solid waste containers with tight-fitting lids in the Facility. Staff and 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. Natalie states that there are no weapons or firearms on the premises. The Facility has a functioning carbon monoxide detector inside the Facility.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Natalie states that the Facility only provides snack to the children since it is not a full day program at this time. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Natalie states that the Facility does not administer any medications.

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. The Facility utilizes the Art Room for activities whenever the children are outdoors. Natalie understands that the Art Room must be supervised at all times whenever the room is in use. There is sufficient shade for the children in the playground area. LPA observed that the outdoor equipment is age appropriate and in good condition. There is no climbing equipment in the playground area. No bodies of water were observed during today's inspection.

LPA conducted an exit interview with Natalie prior to the completion of today's inspection and advised her that no deficiencies issued during today's inspection. Natalie agreed to submit an updated Personnel Report (LIC 500) and Emergency Disaster Plan (LIC 610) to LPA Matos by Friday December 13, 2019.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2