434415610-7-22-2021-07-CC-MSMS-C56RD8-20210722125530

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415610
Report Date: 07/22/2021
Date Signed: 07/22/2021 12:55:39 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:	WINDSOR PRESCHOOL-SUNNYVALE		FACILITY NUMBER:	434415610
ADMINISTRATOR:	SHANAM SAINI		FACILITY TYPE:	850
ADDRESS:	260 SOUTH MARY AVENUE		TELEPHONE:	(408) 746-5666
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	30	CENSUS: 24	DATE:	07/22/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Shanam Saini		TIME COMPLETED:	01:05 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	Licensing Program Analysts (LPAs) Mel Matos and Janette Cruz met with Shanam Saini, Licensee representative/director, for an unannounced Required - 1 year inspection. LPAs toured the Facility (indoor and outdoor areas) during today's inspection. LPAs note that the Facility is licensed in Classrooms 1-4 & Activities Area. LPAs 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. There are no active waivers on file. A review of staff records on July 20, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPAs reminded Shanam of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period. LPAs reviewed ten children's and three staff files (1 director, 2 teachers, and 1 aide (with no ECE units) during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and medical assessment. Sign in and sign out sheets were reviewed and were in compliance, including legal signatures. All staff files reviewed contain the required transcripts/verification of experience/immunization records (including flu vaccine opt out forms) and Health Screening Report (LIC 501). All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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: WINDSOR PRESCHOOL-SUNNYVALE	FACILITY NUMBER: 434415610
	VISIT DATE: 07/22/2021

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/22/2021):

All teachers and Shanam have current CPR and First Aid certifications on file. Shanam 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).

LPAs observed that the teacher/child ratio was in compliance during today's inspection. Shanam understands the conditions, limitations, and capacity specifications of the Facility license. Shanam understands that children shall be visually supervised at all times. LPAs observed one teacher and one aide with 13 preschool children in Classroom 1 and one teacher with 11 preschool children in Classroom 3 during today's inspection. Classrooms 2 & 4 were not in use during today's inspection. 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. Shanam states that the Facility has adequate cleaning/sanitizing supplies & PPE equipment.

LPAs observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Shanam states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Director understands that the Facility must be kept free of flies and other insects & rodents. LPAs observed that all furniture and equipment is in good condition and safe for the children. Drinking water is readily available for the children in the Facility and in the outdoor playground area via water dispensers/disposable cups/water bottles. LPAs observed solid waste containers with tight-fitting lids in each room. 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. Shanam 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. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored in high cabinets/shelves inaccessible to children. Any poisons are stored in the locked storage shed, located in the playground area. Shanam states that the Facility does not administer medication.
REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

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: WINDSOR PRESCHOOL-SUNNYVALE	FACILITY NUMBER: 434415610
	VISIT DATE: 07/22/2021

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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 07/22/2021):

LPAs observed that there is adequate fencing surrounding the playground. The outdoor activity space is equipped with a variety of age-appropriate toys and equipment such as a play structure (which is secure and safe for the children). The area around and under the play structure has artificial grass and cushioning material underneath for resilient materials. Shade is provided by building overhangs and trees. LPAs did not observe any bodies of water during today's inspection. Shanam states that the Facility does not provide transportation.

Licensing Forms, Title 22 Regulations and information can be obtained through the internet at www.cdss.ca.gov.

LPAs conducted an exit interview with Shanam prior to the conclusion of today's inspection 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: 07/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC809 (FAS) - (06/04)

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