434415440-7-28-2022-07-CC-PHEZ-CGRTBP-20220728143527

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415440
Report Date: 07/28/2022
Date Signed: 07/28/2022 02:35:33 PM

Document Has Been Signed on 07/28/2022 02:35 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	CUSD - MUIR CUPERDOODLE PRESCHOOL		FACILITY NUMBER:	434415440
ADMINISTRATOR:	MICHELLE HERRIAGE		FACILITY TYPE:	850
ADDRESS:	6560 HANOVER DRIVE		TELEPHONE:	(408) 252-3000
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	84	CENSUS: 31	DATE:	07/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:26 PM
MET WITH:	Lilly Vazquez		TIME COMPLETED:	02:45 PM

NARRATIVE

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Licensing Program Analyst (LPA) Pete Hernandez conducted an unannounced Required - 1 Year Inspection. The purpose of today’s visit is to ensure the facility is in compliance with Title 22 California Code of Regulations. LPA met with the Lead Teacher and Backup Program Site Director Lilly Vazquez, and explained the nature of today's visit. LPA toured the Facility both inside and outside during todays visit. The Preschool is located on the Muir Elementary School Campus in rooms #26, #27, #29, and #30. but currently only using rooms 26 and 27. 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. The hours of operation are Monday - Friday, 7:30am - 6pm. The facility has an active waiver allowing the preschool to share the playground also utilized by the Cupertino Union School District’s Young Child Center (YCC) Program. Facility hours Monday through Friday 8:00am to 5:00PM

Room 26 had 2 Teachers and 14 Preschoolers Room 27 had 2 Teachers and 17 Preschoolers

LPA reviewed 10 children's and four staff files during today's visit. Each child's file reviewed contains the Information and Emergency Information form (LIC 700), immunization records, physicians report, personal rights, and parents rights. All staff files contain the required transcripts/verification of experience. All staff's CPR and First Aid certifications are current. All staff have clearances through Cupertino Union School District. The 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). Lead Teacher and Director have current CPR and First Aid cards.

Director understands that children shall be visually supervised at all times. LPA observed that all rooms are clean and in order. Drinking water is readily available for the children in each room and in the outdoor playground area via water dispenser, pitchers and cups. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary. 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.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022

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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CUSD - MUIR CUPERDOODLE PRESCHOOL	FACILITY NUMBER: 434415440
	VISIT DATE: 07/28/2022

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The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. Cleaning supplies are securely stored and inaccessible to the children. LPA observed a fully charged 2A10BC fire extinguisher, and working smoke/carbon monoxide detectors. Director states that the Facility does not administer any medications at this time.

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. LPA observed that the outdoor equipment is age appropriate. 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

All staff have completed the Mandated Reporter Training.

TYPE A language: SHOULD THERE EVER BE AN ISSUANCE of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with the Licensee. A copy of this report was discussed and left with the Licensee, Lilly Vazquez, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2022

LIC809 (FAS) - (06/04)

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