434415758-2-28-2020-07-CC-DVIA-BM8PFF-20200228101640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415758
Report Date: 02/28/2020
Date Signed: 02/28/2020 10:16:45 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:	SUTTER DISTRICT PRESCHOOL		FACILITY NUMBER:	434415758
ADMINISTRATOR:	JOY BARTOL		FACILITY TYPE:	850
ADDRESS:	3200 FORBES AVENUE, ROOM 21		TELEPHONE:	(408) 423-4237
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	24	CENSUS: 5	DATE:	02/28/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Judie Stevens		TIME COMPLETED:	10:25 AM

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Licensing Program Analyst (LPA), Deanna Villagrana, conducted an unannounced 1 year required visit to the Facility today. LPA met with Judie Stevens, site supervisor, and explained the nature of today's visit to her. The Facility is licensed in the room 21 located at Sutter Elementary school. The playground area of the Facility is located directly in front of preschool room across the black top located near the kindergarten rooms. Playground is shared with the kindergarten classes and Judie understands preschool and kindergarten may not use the playground at the same time.

LPA toured the Facility both inside and outside for today's inspection. 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, Menus, and Activity Schedule.

Staff are fingerprinted and cleared through Santa Clara County School District. LPA reviewed five children's and one teacher's files during today's inspection. Teacher and children's files were complete. Teacher has a current CPR and First Aid certifications on file. Teacher's filed reviewed contain the required transcripts/verification of experience. Judie 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 visit. LPA observed five preschool children with one teacher and one site supervisor. Judie understands the conditions, limitations, and capacity specifications of the Facility license and understands that children shall be visually supervised at all times. LPA observed that the room is clean and safe for all children and staff. Judie states that the Facility is cleaned by janitorial service provided by the school. Drinking water is readily available for the children via pitchers/disposable cups. LPA observed solid waste containers with tight-fitting lids in the Facility. Children's bathrooms are clean, sanitary, and operable. Staff bathrooms are located in the school office and another separate bathroom not used by children. Judie states that there are no weapons or firearms on the premises.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020

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: SUTTER DISTRICT PRESCHOOL	FACILITY NUMBER: 434415758
	VISIT DATE: 02/28/2020

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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. Cleaning supplies are inaccessible to the children and stored in locked cabinets. Any poisons are stored in locked storage cabinets. Any medications at the Facility are stored in a locked box on the top of the refrigerator. No IMS is administered by the Facility 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 and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. LPA did not observe any bodies of water.

LPA conducted an exit interview with the Judie prior to the conclusion of today's visit and referred Judie to the Department website: www.ccld.ca.gov for additional information on the online training. Licensing Forms, Title 22 Regulations, and information can be obtained through the internet at www.cdss.ca.gov.

No deficiencies were cited during visit.

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

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna Villagrana	TELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020

LIC809 (FAS) - (06/04)

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