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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700721
Report Date: 08/30/2021
Date Signed: 08/30/2021 12:13:59 PM

Document Has Been Signed on 08/30/2021 12:13 PM - It Cannot Be Edited

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:MVWSD PRESCHOOL AT GRAHAMFACILITY NUMBER:
435700721
ADMINISTRATOR:TERRI KEMPERFACILITY TYPE:
850
ADDRESS:1175 CASTRO STREETTELEPHONE:
(650) 526-3560
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94043
CAPACITY: 15TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
08/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Terri KemperTIME COMPLETED:
12:20 PM
NARRATIVE
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On August 30, 2021, at 9:50am, Licensing Program Analyst (LPA) Julia Placencia arrived unannounced for a Required-1 Year inspection, and met with site supervisor Monica Canas and program director Terri Kemper. There were six preschool age children and instructional assistant Angie Cortez present during the inspection. The facility was toured for a health and safety inspection. The center is located on the grounds of MVWSD Graham School. The center's first day of school was August 11th. Hours of operation are Monday through Friday, 8:00am to 11:00am for the morning session, and 12:00pm to 3:00pm for the afternoon session.

Disinfectants, cleaning solutions, poisons and other items that are dangerous to children were inaccessible during the visit. The toilets and sinks were safe, sanitary and in operable condition. Furniture and equipment are in good condition, and floors are free of tripping hazards. Storage areas appear to be clean and free of evidence of rodents. All storage containers for solid waste have tight-fitting covers that are in good repair. Drinking water is available both indoors and outdoors. Menus are posted and visible for parents to view. Currently there are no children on medications. There are no pools or similar bodies of water at this facility. Playground equipment observed to be safe and free of hazards. Climbing equipment is properly anchored to the ground with cushioning material to absorb falls. LPA observed at least two holes in the cushioning (at bottom of slide and in front of steps to play structure), however, director showed LPA a work order was in place for repairs. There is a shaded area provided for the children. Required licensing documents were posted. Fire extinguishers, carbon monoxide and smoke detectors meet State Fire Marshall standards.



The facility is operating within its licensed capacity. The facility is within ratio today with one teacher supervising no more than 12 children. LPA did not observe any child left without visual supervision or unattended during the inspection. A physical census was taken of all children and crossed referenced with the sign in and out sheets.
***Continued on LIC809C...
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MVWSD PRESCHOOL AT GRAHAM
FACILITY NUMBER: 435700721
VISIT DATE: 08/30/2021
NARRATIVE
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At 10:45am, children and staff records were reviewed and contained required licensing documents. Teachers present today meet the qualification requirements. Staff have required immunizations and mandated reporter training.

The following deficiency was observed during today's inspection:
  • At 11:10am, LPA observed that director and assistant's CPR/First Aid is not EMSA approved.

The Director is reminded that ALL Staff must be fingerprint cleared prior to being in the presence of children in care, or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident.

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

Licensee was encouraged to frequently visit our website at www.ccld.ca.gov for licensing regulations and updates, and to also email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list.

See LIC809D for deficiencies cited during today's inspection. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected. Notice of Site visit was provided and must remain posted for 30 days.

Exit interview conducted with director Terri Kemper. Copy of report and appeal rights provided.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Julia Placencia
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/30/2021 12:13 PM - It Cannot Be Edited


Created By: Julia Placencia On 08/30/2021 at 11:49 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MVWSD PRESCHOOL AT GRAHAM
FACILITY NUMBER: 435700721

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2021
Section Cited
CCR
101216(f)

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Personnel Requirements -
At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.
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Director shall ensure that cpr/first aid classes are approved by EMSA, American Red Cross or American Heart Association and will submit copies of cpr/first aid cards to LPA by 9/30/21.
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This requirement is not met as evidenced by:
Based on record review, both staff present(director and assistant) have first aid/cpr training that is not EMSA approved, which is a potential health and safety risk to children in care,
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jason Jang
LICENSING EVALUATOR NAME:Julia Placencia
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2021


LIC809 (FAS) - (06/04)
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