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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440710119
Report Date: 01/06/2020
Date Signed: 01/06/2020 04:24:19 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:SIMCHA PRESCHOOLFACILITY NUMBER:
440710119
ADMINISTRATOR:LISA MENDEZFACILITY TYPE:
850
ADDRESS:3055 PORTER GULCH RDTELEPHONE:
(831) 479-3449
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY:35CENSUS: 13DATE:
01/06/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Lisa MendezTIME COMPLETED:
04:35 PM
NARRATIVE
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Licensing Program Analyst (LPA), Behbood, conducted an unannounced random visit to the Facility today. LPA met with Lisa Mendez, Site Director, explained the nature of today's visit to her. LPA toured the Facility both inside and outside during today's visit.
LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), and Menus (includes current and following week). A review of staff records on 01/03/2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Ms. Mendez is aware of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period. 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 by a parent or authorized representative. Staff have current CPR and First Aid certifications and all staff have proof of immunization on file as well as certificate of completing Mandated Child Abuse Reporter Training. Staff files have copies of their educational background. Furniture & equipment appear in good condition. Floors appear clean. Children's bathrooms are in operating condition. Food in Preschool refrigerator is covered. Trash can for food waste has a tight fitting cover. Menu is posted. Playgrounds were inspected, there are plenty of age appropriate play equipment, tan bark, foam material used for cushioning under the climbing structure. Drinking water inside and outside of the classroom are provided via pitcher and cups, children also bring their water bottle.
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: 01/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
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: SIMCHA PRESCHOOL
FACILITY NUMBER: 440710119
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2020
Section Cited

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Buildings and Grounds - The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. This requirement has not been met evidence by the refrigerator and freezer has lots of food stains and food particle. This is potentially a risk to health and safety of children.

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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: 01/06/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2020
LIC809 (FAS) - (06/04)
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