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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444408897
Report Date: 08/22/2025
Date Signed: 08/22/2025 02:52:25 PM

Document Has Been Signed on 08/22/2025 02:52 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ROLLING HILLS STATE PRESCHOOLFACILITY NUMBER:
444408897
ADMINISTRATOR/
DIRECTOR:		ROSALBA PINEDA INIGUEZFACILITY TYPE:
850
ADDRESS:140 HERMAN AVENUETELEPHONE:
(831) 786-2100
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 6DATE:
08/22/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Rosalba Pineda IniguezTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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On August 22, 2025, Licensing Program Analyst (LPA) Darnella Barnes conducted an unannounced annual Inspection. The purpose was explained to Site Supervisor Rosalba Pineda who granted access and received the Entrance Checklist (LIC 125).

The preschool facility offers two half-day classes: one from 8:30 to 11:30 a.m. and another from 12:30 to 3:30 p.m. As a result, there is no scheduled nap time. Required postings were visible to the public, and the last fire drill was completed on 6/6/25/25. Site Supervisor was reminded of the six-month drill and documentation requirement. LPA observed a fully charged 3A-40-BC fire extinguisher, was last serviced on 6/6/25 is available, along with working smoke and carbon monoxide detectors, and an operating telephone. The Site Supervisor was reminded that smoking is prohibited. The Site Supervisor confirmed there are no firearms on the property. The Site Supervisor, 2 teachers, Director ECE/CDD Lisa Sandoval, Christi Catton, Inclusion Specialist and 5 children were present on site.

Fingerprint clearances for individuals working at the facility are issued by the State Department of Education and/or County Office of Education and do not come under the jurisdiction of Community Care Licensing Division.

Inside the facility, the environment was clean, safe, and well-maintained. The flooring was in good condition and free of tripping or slipping hazards. Toy containers feature smooth edges, appropriate ventilation, and lids designed to prevent finger entrapment. Children were safeguarded from slipping risks, and each child had a clearly labeled space for storing personal belongings.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2025
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
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ROLLING HILLS STATE PRESCHOOL
FACILITY NUMBER: 444408897
VISIT DATE: 08/22/2025
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At the preschool facility, meals for the children are prepared and delivered daily by the PVUSD Food Services Department to the cafeteria at Rolling Hills Middle School. Preschool staff pick up the meals from the middle school cafeteria and bring them to the preschool classrooms. Breakfast is scheduled from 8:40 to 9:00 a.m. for the morning class, and lunch from 12:40 to 1:00 p.m. for the afternoon class. A refrigerator is available in the classroom to safely store perishable items and prevent spoilage. Drinking water is available from the classroom sink, filtered into a container, and served to children in disposable cups.

Cleaning products and chemicals were stored securely in locked cabinets, away from food and out of children’s reach. Floors were mopped and carpets vacuumed daily using water and disinfectants, which were safely disposed of. Trash was discarded in covered containers. Indoor temperature read 73°F.

The bathroom facilities meet the requirement of having at least one sink and toilet for every 15 children. Toileting areas including sinks, dispensers, walls, and floors were regularly cleaned and disinfected. The sink used for rinsing soiled items was sanitized after each use.

LPA Barnes reviewed 5 children's files. All files were complete and included the Admission Agreement, Identification and Emergency Information (LIC 700), Consent for Emergency Medical Treatment (LIC 627), Physician's Report (LIC 701), immunization records, TB test results, Personal Rights (LIC 613A), Notification of Parent’s Rights (LIC 995A), and Child's Pre-admission Health History. LPA reviewed facility roster, sign-in/out and completed using full legal signatures and recorded times.

In addition, LPA Barnes reviewed three staff files (S1–S3). Each file included current Pediatric First Aid/CPR and Mandated Reporter Training certificates, Personnel Record (LIC 501)/job application, Health Screening Report (LIC 503), Statement Acknowledging Requirement to Report Child Abuse (LIC 9108), Employee Rights (LIC 9052) and Education requirements. Files also showed proof of TB clearance, immunization records (pertussis, measles, influenza or declination of influenza).

The Licensing Program Analyst reminded the Site Supervisor that Mandated Reporter Training must be renewed every two years. And there must be one staff that has a current CPR/First Aid certification at all times. LPA also advised Site Supervisor that aides and assistants must be under direct supervision of a qualified teacher except during nap time and taking children to the bathroom.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ROLLING HILLS STATE PRESCHOOL
FACILITY NUMBER: 444408897
VISIT DATE: 08/22/2025
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First-aid supplies were accessible to staff but out of reach of children. The kit included a first aid manual, bandages, scissors, adhesive tape, thermometer, tweezer and antiseptic solution.

This facility provides Incidental Medical Services IMS. LPA reviewed storage of medication administrative records. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-carecenters/.

During the outdoor inspection, LPA observed that all walkways, ramps, and stairs were clear of tripping hazards. The play area had proper shade, was well-organized to prevent accidents, and the ground was free of debris or dangerous items. LPAs observed that the climbing structure is cushioned with material that absorbs falls in and around the structure. Outdoor equipment was age-appropriate, securely anchored, in good condition, and free of sharp edges or loose parts. The outdoor area was fully enclosed by a fence at least five feet high. No dangerous equipment, chemicals, or utility fixtures were accessible.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the Site Supervisor shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).



LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Site Supervisor was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ROLLING HILLS STATE PRESCHOOL
FACILITY NUMBER: 444408897
VISIT DATE: 08/22/2025
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please inspection the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

No deficiency issued during today's inspection.

A notice of site visit was given and must remain posted for 30 days. Appeals right provided

Exit interview conducted and report was reviewed with Site Supervisor, Rosalba Pineda.

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NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Darnella Barnes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC809 (FAS) - (06/04)
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