444408897-12-2-2022-07-CC-CNEN-CLQV9T-20221202151452

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444408897
Report Date: 12/02/2022
Date Signed: 12/02/2022 03:15:25 PM

Document Has Been Signed on 12/02/2022 03:15 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:	ROLLING HILLS STATE PRESCHOOL		FACILITY NUMBER:	444408897
ADMINISTRATOR:	K.LATHROP/R.PINEDA		FACILITY TYPE:	850
ADDRESS:	140 HERMAN AVENUE		TELEPHONE:	(831) 786-2100
CITY:	WATSONVILLE	STATE: CA	ZIP CODE:	95076
CAPACITY:	26	CENSUS: 9	DATE:	12/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Rosalba Pineda & Lisa Sandoval		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Cortney Nelson, met with Site Supervisor, Rosalba Pineda, and Pajaro Valley Unified School District Representative, Lisa Sandoval, for an unannounced Required- 1 Year Inspection. The facility is located at Duncan Holbert School (on the Rolling Hills Middle School Campus) in Room 1. The LPA was granted access to the facility by the Site Supervisor and toured both indoors and outdoors during the inspection. Upon arrival, there were nine (9) preschool-age children, two (2) teachers, and the Site Supervisor present, which is compliant with the facility license capacity and Title 5 ratio requirements. LPA observed all required postings near the entrance to the facility and the hours of operation are Monday – Friday, 9:15AM-12:15PM & 1:00PM-4:00PM (half day preschool programs). 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 11/4/2022, which is compliant with the six-month requirement for facilities. LPA observed a fully charged 2A10BC fire extinguisher (last serviced: 9/2022) and functioning carbon monoxide detector. The facility has a built in fire detection system. The Site Supervisor states that she does currently have children in care who require Incidental Medical Services and does administer medication at this time. LPA observed that children's medication is properly stored out of reach of children with the proper documentation. The Site Supervisor states that there are no weapons or firearms on the premises. 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

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

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: ROLLING HILLS STATE PRESCHOOL	FACILITY NUMBER: 444408897
	VISIT DATE: 12/02/2022

NARRATIVE

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Indoor areas of the facility were inspected by the LPA and observed to be clean, orderly, and safe for the day care children. During todays inspection, LPA observed children eating snack upon arrival and engaging in circle time, singing songs and welcoming one another. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. There is currently a work order for a repair at the preschool as some of the ceiling tiles are becoming unglued. The activity area under the ceiling tiles is barricaded appropriately to keep children out until the repair has been completed. A repair order was submitted and will be completed this upcoming Monday (12/5). Drinking water is readily available for children in the facility via water dispensers and disposable cups. The children's bathroom is sanitary, operable, and equipped with a diaper changing table. 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. The outside area is equipped with a playground, properly maintained sandbox, bikes, and other play equipment for children to utilize. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (tanbark) to absorb falls. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by canopy and building overhang.

Food is provided through the Pajaro Valley Unified School District food services program and is stored and served in a safe and healthful manner to the children. The facility offers a half day program and provides AM/PM snack to children. A monthly snack menu is in writing and posted at least one week in advance, accessible to authorized representatives.

Five (5) children’s files were reviewed during today’s inspection and all required documents were present. Three (3) staff files were reviewed and all required documents were present. All staff members present have current CPR/First-Aid and the Site Supervisors expires 3/27/2023. The Site Supervisor has current Mandated Reporter Training that expires on 2/8/2024. LPA reminded that the Mandated Reporter Training must be renewed by all staff every 2 years.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

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: ROLLING HILLS STATE PRESCHOOL	FACILITY NUMBER: 444408897
	VISIT DATE: 12/02/2022

NARRATIVE

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The Site Supervisor understands that she shall be on the premises during the hours the center is in operation and that children shall be visually supervised at all times. LPA reminded the Site Supervisor 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, such as field trips.

LPA advised that the required water lead testing for Child Care Centers is due by January 1, 2023, and that preschools located on school campuses are still required to complete the lead testing for all faucets utilized for drinking or food preparation.

Exit interview conducted and report was reviewed with the Pajaro Valley Unified School District Representative, Lisa Sandoval.

As a result of today’s inspection, no deficiencies were cited.

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 Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2022

LIC809 (FAS) - (06/04)

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