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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440701509
Report Date: 02/06/2023
Date Signed: 02/06/2023 02:03:59 PM


Document Has Been Signed on 02/06/2023 02:03 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:GREEN VALLEY CHRISTIAN SCHOOLFACILITY NUMBER:
440701509
ADMINISTRATOR:VIVIANA,SEDANOFACILITY TYPE:
850
ADDRESS:376 GREEN VALLEY ROADTELEPHONE:
(831) 724-6505
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:78CENSUS: 21DATE:
02/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Viviana SedanoTIME COMPLETED:
02:13 PM
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Licensing Program Analysts (LPAs), Cortney Nelson and Ashley Lopez, met with Site Director, Viviana Sedano, for an unannounced Required- 1 Year Inspection. LPAs were granted access to Green Valley Christian School by school personnel, Janet Burger, and toured both indoors and outdoors of the preschool program with Viviana. Upon arrival, there were 21 preschool-age children, Viviana, and Areli (fully qualified teacher) present, which is compliant with the facility license capacity and ratio requirements. LPAs observed all required postings near the entrance to classrooms located in the main school building (Rooms: 111/113 & 112/114). LPA's advised that postings are in view of parents for the portable (115/116) and all required postings should be present. The hours of operation are Monday – Friday, 7:30AM-4:30PM.

The Site Director states that waivers on file for shared bathroom and playground use are no longer current. Numbering convention for licensed rooms at the facility additionally need to be updated as room #107 is not used for preschool and classrooms in use are 111/113, 112/114, and portable 115/116. Classrooms have dual numbers due to two doors to access the rooms, however they are one large room inside.

LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. Sign-in/out was observed to be completed with full legal signature and time of day. The last fire/disaster drill was conducted on 1/13/2023, which is compliant with the six-month requirement for facilities. LPA observed a fully charged 3A40BC/2A10BC fire extinguisher (last serviced: 3/2022) and functioning carbon monoxide detector. The facility has built in fire detection system. Viviana states that she has a child in care who require Incidental Medical Services (IMS) and LPA's observed medication is properly stored out of reach of children with documentation. LPA's advised medication for IMS is stored near child with allergies and it was observed to be in Viviana's office. LPA's additionally advised new system to track when medication expires and reminded that it must be in original packaging. There are no weapons or firearms on the premises.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
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 5


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
VISIT DATE: 02/06/2023
NARRATIVE
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This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers, Section 101173 and 101226. The following information regarding ADA was provided: US Department of Justice 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

Indoor areas were inspected by the LPA's today and observed to be clean, orderly, and safe for the day care children. LPA's observed sufficient age-appropriate materials, toys, and play equipment in the facility. Viviana states that in the AM (7:30-10:30AM) the preschool children utilize rooms 112/114 & 111/113 and then switch to portable (115/116) for the remainder of the day. Drinking water is readily available for children via drinking fountain outlets and water bottles from home. Staff and 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 necessary. There is a working telephone in the facility.

The outdoor area of the facility was inspected and observed to be fenced in. LPA's observed play equipment was in good condition and age-appropriate (ages: 2-5). The playground needs additional resilient materials (tanbark) to absorb falls as area under the slides had visible ground underneath. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by large trees and LPA's advised purchasing canopy for additional shade for children.

AM/PM snack is provided by the facility and is stored and served in a safe and healthful manner to the children. All children enrolled provide their own lunch. The snack menu is in writing and posted at least one week in advance, accessible to authorized representatives. LPA's advised that snack menu have serving sizes.

Five (5) children’s files and two (2) staff files were reviewed during today’s inspection and all required documents were present. Viviana has current CPR/First-Aid that expires 6/16/2024 and Mandated Reporter Training that expires on 6/5/2024. LPA's reminded that both must be renewed every 2 years
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
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: GREEN VALLEY CHRISTIAN SCHOOL
FACILITY NUMBER: 440701509
VISIT DATE: 02/06/2023
NARRATIVE
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Viviana understands that she shall be on the premises during the hours the center is in operation and that children at the center shall be visually supervised at all times. LPA's reminded that there shall be at least one person with valid CPR and First-Aid certifications on site at all times and observed that all staff present today have current certifications.

Exit interview conducted and report was reviewed with the Site Director, Viviana Sedano.

As a result of today’s inspection, deficiencies were cited, see 809-D.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/06/2023 02:03 PM - It Cannot Be Edited

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: 02/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(1)(B)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for one EpiPen, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2023
Plan of Correction
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The Site Director will obtain refill of EpiPen (expired: 12/29/2022) and ensure that it is in original packaging with physicians instructions and child's name. Photos of medication to be sent to Licensing by 2/10/2023.
Type B
Section Cited
CCR
101238.2(e)
Outdoor Activity Space
(e) 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above as cushioning material under the slide had visible ground, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/20/2023
Plan of Correction
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The Site Director will order more tanbark and ensure that areas such as underneath slides are regularly maintained for tanbark levels and that ground should not be visible. LPA's advised ordering additional tanbark. Site Director will submit photos of additional tanbark and order form for additional tanbark to be submitted by 2/20/2023.
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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 02/06/2023 02:03 PM - It Cannot Be Edited

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: 02/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(5)
Health-Related Services
(5) The licensee shall develop and implement a written plan to record the administration of prescription and nonprescription medications and to inform the child's authorized representative daily when such medications have been given.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for one EpiPen, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/10/2023
Plan of Correction
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The Site Director will submit Incidental Medical Services (IMS) plan and indicate how medication will be monitored for expiration date, administration date, and parent/physican consent for all medication given to the center. Plan to be submitted to Licensing by 2/10/2023.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
LIC809 (FAS) - (06/04)
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