435700706-7-31-2019-52-CC-MMEA-BELRPH-20190731131157

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700706
Report Date: 07/31/2019
Date Signed: 07/31/2019 01:12:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CUSD MONTCLAIRE CUPERDOODLE PRESCHOOL		FACILITY NUMBER:	435700706
ADMINISTRATOR:	MICHELLE HERRIGE		FACILITY TYPE:	850
ADDRESS:	1160 ST. JOSEPH AVENUE		TELEPHONE:	(408) 252-3000
CITY:	LOS ALTOS	STATE: CA	ZIP CODE:	94024
CAPACITY:	24	CENSUS: 0	DATE:	07/31/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Michelle Herriage & Daric Jackson		TIME COMPLETED:	01:30 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	A Prelicensing Visit was conducted today 7/31/19 by Licensing Program Analysts (LPAs) Mayla Mendoza and Paul Petersen. LPAs met with District Director, Michelle Herriage and Principal Daric Jackson. The applicant has submitted an application for a Relocation from 19200 Phil Lane, Cupertino to 1160 St. Joseph Ave. Program is located on the campus of Montclair Elementary School in Room 23. The program will operate from 7:30AM - 6:00PM in one classroom. A health and safety inspection was conducted inside and outside and the measurements are as follows: INDOORS: 927.6926 square feet = 26 children OUTDOORS: 10685.25 square feet = 142 children The preschool room is equipped with varied age appropriate materials and equipment. There are 3 toilets and 4 sinks available for children. The main office in the nurses station and the staff toilet will serve as isolation areas for sick children. There is a prep area. There are 2 play yards (Kinder Play ground and Preschool Play ground). Kinder playground is fenced in all around. The climbing structure in the Kinder Playground is not preschool appropriate and will not have access to the structure. The blacktop is the only accessible area in the Kinder Playground for the preschoolers. The climbing structure on the Preschool Playground is sufficiently cushioned with tanbark. Trees, building overhang and a canopy provide sufficient shade in both play yards. The center has functioning drinking fountains inside, jugs and cups, as well as water bottles for indoor and outdoor activities. The center will provide snacks. No cleaning agents were found stored with food. First aid supplies are available in the center. There is a working telephone on site. Carbon monoxide is available. The sign in/out sheets provide for a full signature.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2019

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CUSD MONTCLAIRE CUPERDOODLE PRESCHOOL	FACILITY NUMBER: 435700706
	VISIT DATE: 07/31/2019

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A 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.

Yee "Alice" Chan is a fully-qualified preschool director and has completed 16 hours of health and safety training including pediatric CPR and First Aid which is valid thru 11/13/20.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

Zero Tolerance policies were explained. The center was found to be clean, safe, sanitary, and in good repair.

A license for 24 children will be issued pending:

*fence completion of yard
*fire clearance

An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Mayla Mendoza	TELEPHONE: (510) 292-9724
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2019

LIC809 (FAS) - (06/04)

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