434415793-11-22-2019-07-CC-SCRL-BJ6TGX-20191122134354

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415793
Report Date: 11/22/2019
Date Signed: 11/22/2019 01:43:59 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:	CSI PRESCHOOL		FACILITY NUMBER:	434415793
ADMINISTRATOR:	HEATHER ELSTON		FACILITY TYPE:	850
ADDRESS:	295 W. CHERRY LANE		TELEPHONE:	(408) 410-7223
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY:	30	CENSUS: 20	DATE:	11/22/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Xochilt Garcia		TIME COMPLETED:	02:00 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 Analyst (LPA), Stephanie Rangel, conducted an unannounced random inspection to the Facility today. LPA met with CDC Specialist III, Xochilt Garcia and explained the nature of today's inspection to her. LPA toured the Facility both inside and outside during today's inspection. Facility operates from 7:00am to 5:00pm, Monday through Friday in rooms A5 and A6. 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. A review of staff records indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions through the school district. Sign in and out sheet reviewed. LPA reviewed 10 children's and 5 staff files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). The staff files reviewed contains the required transcripts/verification of experience, the required immunizations needed per SB 792 and Mandated Reporter Training per AB 1207. Xochilt has current CPR and First Aid certifications on file with an expiration date of 8/13/21. Xochilt 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). Last fire drill completed 11/19/19. LPA observed that the teacher/child ratio was in compliance during today's inspection. Xochilt understands the conditions, limitations, and capacity specifications of the Facility license. Xochilt understands that children shall be visually supervised at all times. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2)

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

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: CSI PRESCHOOL	FACILITY NUMBER: 434415793
	VISIT DATE: 11/22/2019

NARRATIVE

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LPA observed that the rooms are clean and safe for all children and staff. LPA observed solid waste containers with tight-fitting lids throughout the Facility. 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.

The food preparation and storage areas are clean. All food and beverages that require refrigeration are stored in covered containers. Cleaning supplies are stored on high shelves in the kitchen area, away from children. Xochilt understands that any poisons are to be locked away from children. Any medication(s) at the Facility will be stored in the locked box on a shelf. 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. Drinking water is readily available for the children in the Facility and in the outdoor playground area via water bottles and through two outside drinking fountains. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient materials in the outdoor playground area. 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

Periodic information releases accessible by signing up at: www.myccl.ca.gov. Facility has been giving out the Effect of Lead Exposure handout dated 1/20/19. Xochilt understands that per Assembly Bill (AB 2370), written information regarding lead exposure needs to be given out to enrolling and re-enrolling parents or guardians.

As a result of today's inspection, no deficiencies cited. A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019

LIC809 (FAS) - (06/04)

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