434414503-10-18-2022-52-CC-MESA-CKBSUX-20221018141154

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414503
Report Date: 10/18/2022
Date Signed: 10/18/2022 02:12:08 PM

Document Has Been Signed on 10/18/2022 02:12 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:	ST. THOMAS PRESCHOOL		FACILITY NUMBER:	434414503
ADMINISTRATOR:	EFREN LORENZ TIGAS		FACILITY TYPE:	850
ADDRESS:	200 NORTH ABBOTT AVENUE		TELEPHONE:	(408) 946-0190
CITY:	MILPITAS	STATE: CA	ZIP CODE:	95035
CAPACITY:	68	CENSUS: 34	DATE:	10/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Mabel Bibiana Solorio		TIME COMPLETED:	02:30 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 Tuesday, October 18, 2022 at 11 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced Required One (1) Year Visit. LPA met with the Facility Representative (FR) Mabel Bibiana Solorio and explained the nature of site visit. Present on this visit were 6 staff and 34 preschool children. Facility operates from Monday to Friday 8 am to 6 pm. LPA toured the facility to conduct a Health and Safety Inspection with the FR. Facility’s License, Parents’ Rights Poster, Personal Rights, Activity Schedules, and Waivers were observed to be posted. Facility was observed to be following teacher to children ratio requirement. Children were engaged in various activities under the visual supervision of the teachers. Facility has a total of 3 operating classroom, Dolphin Room, Parrot Room and Rainforest Room. The classrooms, restrooms, storage rooms and office area were inspected. There is an outdoor children's bathroom located next to the outdoor storage area and Staff Restroom is located inside the Church next to the outdoor play area. The FR stated that children are being assisted and supervised when using the bathroom. The sick child will use the staff bathroom if needed. The sick child will be isolated in the multi-purpose room located in the church building. Restrooms were observed to be in safe, sanitary, and functioning condition. FR stated that facility does not possess nor store any weapons on the premises. Furniture and equipment such as mats, cots, tables, and chairs were age appropriate and were in good condition, free of sharp, loose, or pointed parts. Floors were clean and free from tripping hazard. Outdoor activity space is fenced and play equipment were maintained in a safe condition and free of hazards. There were no bodies of water observed. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were shaded rest areas for children. Drinking water are arranged to be readily available to children during indoor and outdoor activities. SEE 809 C.......

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ST. THOMAS PRESCHOOL	FACILITY NUMBER: 434414503
	VISIT DATE: 10/18/2022

NARRATIVE

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Continuation.

Facility Representative stated that children bring their lunch and facility provides am and pm snacks. Menus for snacks were observed to be posted. Trash cans for solid waste had tight-fitting covers on and were in good repair.
Facility does not provide transportation for children, but Director understands that children cannot be left alone, unattended in park vehicles.

LPA reviewed the following with the Director;

1. Facility file which Fire and Earthquake Drills were conducted and documented on 08/17/22 and 09/07/22 respectively. LPA observed Smoke and Carbon Monoxide Detectors, fire pull stations, fire extinguishers and sprinkler system.
2. Children’s Sign in and Out Records for today. LPA obtained copies.
3. Children's checklist / attendance in each room.
4. Staff Files. Each file includes but not limited to Criminal Record and Child Abuse Index Clearance, Health Screening Report with TB Clearance, Education Qualification, records of immunization (Measles, Pertussis and Influenza that can optional with Declination Statement), and Training such as the AB1207 Mandated Reporter Certification and certification in Pediatric CPR and First.
5. Children Files. Each child’s file contains but not limited to records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form and Immunization.
LPA also obtained copies of the Facility's updated Personnel Report, Child Care Facility Roster, October 2022 Menu, Facility's current Enrollment Packet and updated LIC 610.

LPA Estoesta discussed and provided copies of the following;
1. Provider Information for Parents & Families about Lead Poisoning and reminded that licensee must provide the Risks and Effects of Lead Poisoning PUB 515 flyer to parents and families upon enrolling or reenrolling.
2. PIN 21-21 CCP RELEASE OF THE WRITTEN DIRECTIVES FOR LEAD TESTING OF WATER IN LICENSED CHILD CARE CENTERS PER AB 2370
3. Guardian New User Information
4. LIC 311 D

SEE 809 C.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ST. THOMAS PRESCHOOL	FACILITY NUMBER: 434414503
	VISIT DATE: 10/18/2022

NARRATIVE

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Continuation.

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

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/inspection-process.

Directors were reminded that all adults 18 and over, 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 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.

Included in this report are the Technical Violations and Technical Assistance, see LIC 9102.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Facility Representative, Mabel Bibiana Solorio.

SUPERVISOR'S NAME: Jason Jang	TELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel Estoesta	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC809 (FAS) - (06/04)

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