434414117-3-3-2020-07-CC-DMAC-BMCPMQ-20200303102643

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414117
Report Date: 03/03/2020
Date Signed: 03/03/2020 10:26:49 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:	CHRISTOPHER STATE PRESCHOOL		FACILITY NUMBER:	434414117
ADMINISTRATOR:	CARMODY, BARBARA		FACILITY TYPE:	850
ADDRESS:	565 COYOTE ROAD		TELEPHONE:	(408) 573-3341
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	24	CENSUS: 18	DATE:	03/03/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Rocio Blankenship		TIME COMPLETED:	10:35 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 Analysts (LPA) Dung Mac conducted an unannounced annual inspection to the facility today. LPA met with Rocio Blankenship, Site Director at 8:15am, and explained the nature of today's visit. The Facility is licensed in Rooms K1 and K2. The program is operated by the Santa Clara County Office of Education and all criminal background checks for staff are handled by the Department of Education and thus do not come under the jurisdiction of Community Care Licensing Division. LPA reviewed staff and children files at 8:30am. All staff and children files were complete. Staff files contain appropriate documentation of education credits. LPA observed two staff have current CPR and First Aid certifications on file. LPA observed there is a copy of Admission Agreement in each child file. LPA observed child is signed in/out by the person responsible for the child. LPA toured the Facility both inside and outside at 8:48am. LPA did not observe any bodies of water. Rocio states that there are no weapons or firearms on the premises. LPA observed all required materials posted in classroom. LPA observed all children are under supervision at all times. LPA observed the teacher/child ratio was in compliance during today's visit. LPA observed cleaning supplies are inaccessible to the children. LPA observed all materials and surfaces accessible to children are toxic free. LPA observed medications are in a safe place inaccessible to children. LPA observed children's bathroom is in safe and sanitary operating function. LPA observed the facility is clean and safe for children. LPA observed furniture and equipment are in good condition, free of sharp or pointed parts. LPA observed solid waste containers with tight-fitting lids in the facility. Facility provides snacks only and snack is brought by Revolution Foods. Drinking water is available both indoor and outdoor. LPA observed that classroom has one functioning carbon monoxide. Contiued on Page #2

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

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: CHRISTOPHER STATE PRESCHOOL	FACILITY NUMBER: 434414117
	VISIT DATE: 03/03/2020

NARRATIVE

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LPA observed that playground is fenced and gated. LPA observed playground has a concrete ground for children to ride bikes. LPA observed no climbing structures. Facility is currently administering medications. Incidental Medical Services (IMS) was discussed. Incidental Medical Services (IMS) was discussed. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) and Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA conducted an exit interview with the Rocio. No deficiencies were cited during visit. A Notice of Site Visit was issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2020

LIC809 (FAS) - (06/04)

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