434414750-9-2-2021-07-CC-MSMS-C6GP27-20210902105529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414750
Report Date: 09/02/2021
Date Signed: 09/02/2021 10:55:35 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:	SSD STATE PRESCHOOL-LAKEWOOD		FACILITY NUMBER:	434414750
ADMINISTRATOR:	KIM ANH LE		FACILITY TYPE:	850
ADDRESS:	750 LAKECHIME DRIVE		TELEPHONE:	(408) 522-8213
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94089
CAPACITY:	48	CENSUS: 21	DATE:	09/02/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Stacy Esquibel		TIME COMPLETED:	11:00 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 Stacy Esquibel, preschool program manager, for an unannounced Required - 1 year inspection (KIT 2). LPA toured the indoor and outdoor space of the Facility with Stacy during today's inspection. LPA notes that the Facility is licensed in Room P1, P2, & Y2 on the campus of Lakewood Elementary School. Hours of operation are: 8:15 AM-11:15 AM & 12 PM to 3 PM Monday to Friday. The Facility is open during the calendar school year for the Sunnyvale School District and closed during school holiday/recess periods. 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 one waiver (shared playground space with Kindergarten program) and is in compliance with the terms & conditions of the waiver. The program is operated by the Sunnyvale School District 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 ten children's and four staff files (1 director & 3 teachers) during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). All staff files reviewed contain the required transcripts/verification of experience/immunization records and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. There is at least one staff at the Facility with current CPR and First Aid certifications on file. Stacy 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. Stacy understands the conditions, limitations, and capacity specifications of the Facility license. Stacy understands that children shall be visually supervised at all times.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

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: SSD STATE PRESCHOOL-LAKEWOOD	FACILITY NUMBER: 434414750
	VISIT DATE: 09/02/2021

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LPA observed the director & one teacher with six preschool children in Room Y3 and two teachers with 15 preschool children in Room Y2 during today's inspection. LPA notes that the Facility is Title 5 funded and thus Title 5 ratios apply. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the director’s office area.

LPA observed that Rooms P1, P2, & Y3 is clean and safe for all children, staff, and visitors. Stacy states that staff from the Sunnyvale School District clean the Facility Monday through Friday in the evenings. Drinking water is readily available for the children in Rooms P1, P2, & Y3 and in the outdoor playground area via water fountains, water bottles, & water coolers/disposable cups. 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. Stacy states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. The Facility only serves snacks since it only operates AM & PM half day programs. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. LPA observed solid waste containers with tight-fitting lids in Rooms P1, P2, & Y3 and outdoors. Cleaning supplies are inaccessible to the children and stored inaccessible to children. Any poisons are stored in the locked janitor's closet on campus.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground areas utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade is provided by trees and canopies. There is sufficient resilient materials (artificial grass with rubber surfacing & rubber squares) in the outdoor playground areas. LPA did not observe any bodies of water.

LPA conducted an exit interview with Stacy and advised her that no deficiencies issued during today's inspection.

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 Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021

LIC809 (FAS) - (06/04)

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