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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440701509
Report Date: 05/23/2019
Date Signed: 05/23/2019 03:25:23 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:GREEN VALLEY CHRISTIAN SCHOOLFACILITY NUMBER:
440701509
ADMINISTRATOR:LINDA WILLIAMSFACILITY TYPE:
850
ADDRESS:376 GREEN VALLEY ROADTELEPHONE:
(831) 724-6505
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:78CENSUS: 19DATE:
05/23/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:TIME COMPLETED:
03:40 PM
NARRATIVE
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an unannounced random visit made by Analyst Mahvash Behbood. Met Linda Williams, Site Director. present also were 19 children and 2 staff. Operation hours is M-F from 7:30 to 5:30 PM. Indoor and outdoor of the facility was toured.
Menu, licenses, Personal Rights, Car Seat Poster & Parent's Rights are all posted.
LPA reviewed samples of children's file and sign in and out sheets during today's visit. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and a copy of the admission agreement. LPA observed that all children were properly signed in and out (legal signature & time of day) by a parent or authorized representative. some staff have current CPR and First Aid certifications and proof of immunization on file . Staff files have copies of their educational background.
Teacher/infant ratio was met during the visit.
Furniture & equipment appear in good condition. Floors appear clean. Children's bathrooms are in operating condition. There are no medications at the Center. Ms. Williams understands If/ when medication is accepted to administer by center all medication must be in their original container accompanied by parent's and physician's permission/direction in addition to the mediation log
Playground has climbing structures, sand boxes, etc. Wood chips are used for cushioning material.
Drinking water inside the classrooms and in the playground are provided via water fountains. Center provides snacks the children bring lunch from home. The menu is posted & has the required food groups. There is small refrigerator to store milk and the fruit is coming from the elementary school kitchen. There is a trash can with a tight-fitting cover. children were visually supervised.
They provide IMS if there is a need, this year none of the children requires epi-pen or inhaler.
See next page for citation under Title 22.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
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: GREEN VALLEY CHRISTIAN SCHOOL
FACILITY NUMBER: 440701509
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2019
Section Cited
CCR
101238(a)
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Buildings and Grounds. The child care center shall be clean, safe, sanitary and in good repair at all times.
LPA observed drinking water in back yard is leaking and water pressure is low. This is potentially dangerous to health and safety of children,
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Must be corrected by the due date.
Type B
05/31/2019
Section Cited
HSC
1596.7995
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SB 792 IMMUNIZATION REQUIREMENT
Some of the staff doesn't have proof of immunization against pertussis and measles. This is potentially dangerous to health and safety of children,
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Must be corrected by the due date.
Type B
05/23/2019
Section Cited
CCR
101238.2(e)
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As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls. The wood chips in the play area are not evenly distributed. In some areas (around the climbing structures) the ground is visible. This is potentially dangerous to health and safety of children,
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Must be corrected by the due date.
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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: GREEN VALLEY CHRISTIAN SCHOOL
FACILITY NUMBER: 440701509
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/23/2019
Section Cited
CCR
101170(2)(C)
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Criminal Record Clearance - Section 1596.871(b) of the Health and Safety Code provides in part:Any person who provides care and supervision to the children. One staff didn't have criminal record clearance. This is an immediate danger to health and safety of children.
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Copy of processed live scan must be forwarded to analyst by 05/24/19.
A civil penalty of $500 was assessed during tody'a visit.
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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3