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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440702577
Report Date: 06/20/2019
Date Signed: 06/20/2019 10:59:36 AM

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:YWCA STATE PRESCHOOL CENTERFACILITY NUMBER:
440702577
ADMINISTRATOR:ANGELINA GOMEZFACILITY TYPE:
850
ADDRESS:118 SECOND STEETTELEPHONE:
(831) 768-0900
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY:48CENSUS: 35DATE:
06/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Angelina GomezTIME COMPLETED:
11:05 AM
NARRATIVE
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Unannounced random visit made by Analyst Mahvash Behbood. Met Angelina Gomez, Director, purpose of the visit explained. Present also were 35 children and 6 direct care staff. Operation hours is M-F from 8:00 to 4:30, AM and PM sessions. 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. Staff have current CPR and First Aid certifications and proof of immunization on file . Staff files have copies of their educational background. Teacher ratio was met during the visit.
A sampling of children's files were reviewed & are complete.
Furniture & equipment appear in good condition. Floors appear clean. Children's bathrooms are in operating condition.
Playground has climbing structures, , sand boxes, etc. Wood chips are used for cushioning material. Shades are provided by canopies and building.
Drinking water inside the classrooms and in the playground are provided via water containers.
Center provides AM and PM snacks. The menu is posted & has the required food groups. Snacks are prepared on premises. Kitchen appears clean. All food is covered & there is a trash can with a tight-fitting cover. children were visually supervised.
Facility Provide IMS Services if there is a need. This year none of the children requires this service. Lead poisening poster was provided to be shared with parents.
Please 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: 06/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
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: YWCA STATE PRESCHOOL CENTER
FACILITY NUMBER: 440702577
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2019
Section Cited
CCR
101229.1(b)
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Sign in and Sign out - The person who brings the child to, and removes the child from, the center shall sign the child in/out.
At least 4 children is Room B were not signed in. This is potentially dangerous to health and safety of children.
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Send a letter to all parents reminding them of their responsibility to sign in and out their children. Copy of the letter to be forwarded to analyst no later than 06/18/19.
Type B
06/28/2019
Section Cited
HSC
1596.8662(b)
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Mandated Reporter Training. From all the personnel file reviewed only two staff have completed the Mandated Child Abuse Training. This is potentially dangerous to health and safety of children.
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Staff to complete the training and send the certificate to analyst no later than 06/28/19.
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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: 06/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2019
LIC809 (FAS) - (06/04)
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