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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440710119
Report Date: 06/06/2024
Date Signed: 06/06/2024 02:58:10 PM

Document Has Been Signed on 06/06/2024 02:58 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:SIMCHA PRESCHOOLFACILITY NUMBER:
440710119
ADMINISTRATOR/
DIRECTOR:
CAITLIN CLANCYFACILITY TYPE:
850
ADDRESS:3055 PORTER GULCH RDTELEPHONE:
(831) 479-3449
CITY:APTOSSTATE: CAZIP CODE:
95003
CAPACITY: 49TOTAL ENROLLED CHILDREN: 49CENSUS: 34DATE:
06/06/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Caitlin Clancy TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Larios conducted an unannounced Required - 3 Year Inspection. The purpose of today’s visit is to ensure the facility is in compliance with Title 22 California Code of Regulations. LPA met with the Director Caitlin Clancy, and explained the nature of today's visit. LPA toured the facility both inside and outside during 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), Child Car Seat Law (PUB 269), and activity schedule in each classroom. The hours of operation are Monday - Friday, 7:30am - 5:30pm.

LPA reviewed children's files during today's visit. Each child's file reviewed contains the Information and Emergency Information form (LIC 700), immunization records, physicians report, personal rights, and parents rights. LPA reviewed staff files during today's visit. All staff have fingerprint clearances. Staff has current CPR and First Aid certifications on file. Staff have Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record and required Training. Staff had current Mandated Reporter Training certificate. Director understands that there shall be at least one person with valid CPR and First Aid certifications on site at all times, or present during off-site activities.

LPA will resume inspection at a later time.

Exit interview was conducted, where this report was reviewed and discussed with Director Caitlin. A copy of this report was also provided.



A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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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