434415457-11-6-2019-07-CC-AALZ-BHP27C-20191106160832

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415457
Report Date: 11/06/2019
Date Signed: 11/06/2019 04:08:41 PM

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:	ALLEN @ STEINBECK PRESCHOOL		FACILITY NUMBER:	434415457
ADMINISTRATOR:	CLAUDIA PATERSON		FACILITY TYPE:	850
ADDRESS:	820 STEINBECK DRIVE		TELEPHONE:	(408) 535-6205
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	24	CENSUS:	DATE:	11/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Flores, Susan		TIME COMPLETED:	04:26 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	An unannounced Annual Random Inspection was conducted on this day by Licensing Program Analyst (LPA) Almaraz, Araceli. Facility is currently licensed for a capacity of 24. Licensing staff met with teacher Flores, Susan Director qualified. The program currently operates from 8:00AM to 3:00PM, Monday thru Friday. There are two, three hour session for the children in care, 8:00AM to 11:00AM and 12:00PM to 3:00PM, daily. Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. At the initial start of the site visit, there is a total census of 14 children. There was one teacher/staff present and one aide. All areas identified on the Facility Sketch were inspected. The following was observed by LPA Almaraz of this facility. PHYSICAL PLANT: This is a preschool program which consists of classroom Room F4: Upon arrival room F4 had one teachers/staff, one aide with 14 preschool children. Access to two toilets and two sinks and drinking water located inside classroom. Furniture and equipment was inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings was observed. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. Toys observed to be clean. Outdoor equipment was inspected for safety, cushioning material, good repair and appropriateness. Required shade, drinking water and fencing were inspected. LPA Almaraz advised that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. The children have access to drinking fountains during outside play. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed. ***Page 1/3, Report Continued on Page 2***

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

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: ALLEN @ STEINBECK PRESCHOOL	FACILITY NUMBER: 434415457
	VISIT DATE: 11/06/2019

NARRATIVE

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The fire extinguisher type 3A40BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The acting Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Acting Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. The Acting Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA advised that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check.

LPA informed Acting Director to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.

The Acting Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised to visit www.shotsforschool.org for immunization information. Acting Director advised that indoor and outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.
These forms may also be downloaded from our website: www.ccld.ca.gov

NOTICE OF SITE VISIT ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1. Exit interview and a copy of report provided.*****Page 3/3, Final Page of Report Continued From Page 2*****

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: ALLEN @ STEINBECK PRESCHOOL	FACILITY NUMBER: 434415457
	VISIT DATE: 11/06/2019

NARRATIVE

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A first aid kit is kept in a backpack. Carbon monoxide detectors and smoke detectors are present in the facility. Fire extinguishers have been serviced in 03/19/2019. Last fire drill was done on 10/30/2019. Hazardous items including poisonous cleaning compounds were stored inaccessible to children.

Due to the programs three hour sessions, no napping takes place. The AM class receives breakfast, PM receives lunch both from school district . Breakfast/lunch is optional, children can bring from home.

Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. Personal Rights of children were observed by LPA.

Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. Fingerprints are done through San Jose Unified School District. Inspection of required forms made.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

The following was discussed with acting Director Flores:
Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. No infant walkers, no Johnny Jumpers, no excersaucers or any other item that falls into that category are allowed in facility.

The acting Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA also provided a complete packet of the Provider Information Network (PIN) 10-02-CCP dated February 20, 2019 regarding Safe Sleep Awareness Campaign during today’s inspection.

*****Page 2/3, Report Continued on Page 3*****

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

LIC809 (FAS) - (06/04)

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