444415615-12-17-2021-07-CC-SYIP-C9ST8S-20211217133049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444415615
Report Date: 12/17/2021
Date Signed: 12/17/2021 01:31:05 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:	COASTAL COMMUNITY PRESCHOOL		FACILITY NUMBER:	444415615
ADMINISTRATOR:	STEPHANIE SIMMONS		FACILITY TYPE:	840
ADDRESS:	900 HIGH STREET		TELEPHONE:	(831) 462-5437
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95060
CAPACITY:	16	CENSUS: 2	DATE:	12/17/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:14 AM
MET WITH:	Stephanie Simmons		TIME COMPLETED:	01:40 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) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Director Stephanie Simmons and explained the reason for the inspection. There were no children present upon arrival. Two children arrived at 12:15PM. There is board to post required postings, such as earthquake preparedness checklist. LPA observed that notification parent's right was posted in the preschool area, where parents can see it. LPA reviewed sign in/sign out sheet. The hours of operation are Monday through Friday 12PM to 5:30PM. LPA toured the facility with Director Stephanie Simmons. Disinfectant, cleaning supplies, and other items that could pose a risk to children in care were inaccessible. There is sufficient amount of toys for children. All equipment and furniture were observed to be in good condition. The bathroom for children was observed to be clean. LPA observed that there was only 1 toilet and 2 sinks in the facility. LPA discussed with Director about how she needs to have at least 1 toilet for every 15 children. Director stated she will apply for a change of capacity to 15 children and will mail in the updated LIC 200A to Licensing. There is fully charged fire extinguisher, sprinkler system, and carbon monoxide detector. LPA reminded Director that all centers need to have a least one carbon monoxide detector. The outside area is fenced. Areas around play structure have resilient material to absorb falls. Director stated that the school age program uses the same outdoor space as the preschool program. Outdoor space is used during the preschool's nap time (12:30PM- 1:30PM). Director submitted a waiver request during today's inspection. --------------------------continues on 809 dated 12/17/2021 page 2--------------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

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

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: COASTAL COMMUNITY PRESCHOOL	FACILITY NUMBER: 444415615
	VISIT DATE: 12/17/2021

NARRATIVE

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---------------------------continuation of 809 dated 12/17/2021 page 2-----------------------------

All meals and snacks are prepared and brought from home. Facility does have back-up food for children. Drinking water inside and outside are provided through individual water bottles and water jugs.

This facility provides Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) 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

Three (3) children's files were reviewed during today's inspection. The records reviewed include but not limited to emergency contact card.

Three (3) staff files were also reviewed during today's inspection. The records reviewed include but not limited to Mandated Reporter Training, transcript, immunization records, and Health Screening. LPA reminded Director that the Mandated Reporter training needs to renewed every two years. S-1 has not renewed Mandated Reporter training. Director stated that she will submit proof to Licensing. Director has a valid CPR/1st Aid, which expires on 08/2023.

LPA observed two staff with school-age program. S-2 has cleared fingerprint clearance and is associated to the preschool license, but not to the school-age license. Director transferred S-2's fingerprints to the school-age program during today's inspection. Director Stephanie was reminded that all adults 18 and over, including employees and volunteers,

----------------------continues on 809 dated 12/17/2021 page 3-----------------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: COASTAL COMMUNITY PRESCHOOL	FACILITY NUMBER: 444415615
	VISIT DATE: 12/17/2021

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------------------------continuation of 809 dated 12/17/2021 page 2--------------------------------

must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Director will submit the following:
- LIC 200A with a change of capacity fee to Licensing
- S-1's Mandated Reporter training.

As a result of this inspection, two Type B citation and technical violations were issued. A civil penalty of $100 was assessed for Caregiver Background Check. Exit interview conducted and report was reviewed with Director Stephanie Simmons. A notice of site visit was given and must be posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

LIC809 (FAS) - (06/04)

Page: 3 of 5

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: COASTAL COMMUNITY PRESCHOOL	FACILITY NUMBER: 444415615
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/17/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reviews, the licensee did not comply with the section cited above. S-1 has not renewed Mandated Reporter training, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/04/2022
	Plan of Correction
1 2 3 4	By POC 02/04/2021, Director stated that S-1 will renew Mandated Reporter training and send proof to Licensing.

Type B

Section Cited

CCR

101170(e)(2)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. S-2 was present with the children and has cleared fingerprints. S-2 is associated to the preschool license and not the school age license, which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/17/2021
	Plan of Correction
1 2 3 4	Deficiency was corrected during today's inspection. Director transfered S-2's fingerprints to school-age license during today's inspection.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

LIC809 (FAS) - (06/04)

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