444416685-7-14-2021-07-CC-KGOL-C4WUQH-20210714154710

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444416685
Report Date: 07/14/2021
Date Signed: 07/14/2021 03:47:18 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:	SECRET GARDEN PRESCHOOL, THE		FACILITY NUMBER:	444416685
ADMINISTRATOR:	PORSCH, LISA		FACILITY TYPE:	850
ADDRESS:	26 FLORIDO AVENUE		TELEPHONE:	(801) 652-4417
CITY:	LA SELVA BEACH	STATE: CA	ZIP CODE:	95076
CAPACITY:	39	CENSUS: 14	DATE:	07/14/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Lisa Porsch		TIME COMPLETED:	04:15 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	On 7/1/21, Licensing Program Analyst (LPA), Goodell met with Director Lisa Porsch for an unannounced Annual Inspection. The facility’s hours of operation are Monday- Friday, 7:00AM- 5:30PM. LPA conducted a census of 12 children present with 2 staff in the outdoor area and 5 children napping with 1 staff member present. All individuals present have obtained fingerprint clearance through Community Care Licensing. LPA observed required postings: Facility License (LIC 203A), Personal Rights (LIC9040), Emergency Disaster Plan (LIC610), Earthquake Preparedness Checklist (LIC9148), and Parent’s Rights Poster (PUB393). LPA toured all activity/classroom areas, children’s furniture, play equipment, napping equipment, food service area, and restrooms. Due to COVID guidelines LPA observed parent sign/out station located at the entrance of the facility. Facility provides morning/afternoon snack and lunch. LPA observed current menu and activity schedule posted. LPA observed outdoor area and play equipment. LPA observed ground visible in areas of the climbing structure which poses a potential risk to children in care due cushioning is required to observe a fall. Proof of additional cushion will be submitted to LPA via email by 08/2/21. LPA observed drinking water is readily available to children. LPA observed cleaning supplies and medication boxes stored inaccessible to children. LPA observed water is accessible to children both indoor and outdoor. LPA observed fire extinguisher 3A40BC,dual smoke and carbon monoxide detectors. LPA observe fire drill log and children roster maintained. Report continues on LIC 809-C

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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: SECRET GARDEN PRESCHOOL, THE	FACILITY NUMBER: 444416685
	VISIT DATE: 07/14/2021

NARRATIVE

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LPA reviewed children files. Documents included Identification and Emergency Information (LIC700), Child’s Preadmission Health History (LIC702), Child’s Preadmission Health Evaluation (LIC701), Consent for Medical Treatment (LIC627), Notification of Parent’s Rights (LIC 995), Personal Rights (LIC613A).

LPA reviewed staff files and educational requirements. Documents included Health Screening Report (LIC503), TB Clearance, Personal Record (LIC501), Criminal Record Statement (LIC508), Notice of Employee Rights, Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC9108) and certificate for Mandated Reporter Training. LPA observed that at least one staff member present during today’s inspection has current Pediatric CPR/First Aid that expires on 1/21/23.

The Effects of Lead Exposure brochure was issued and discussed. Assembly Bill 2370, which will require licensed Child Care Facilities to test their water for excessive amounts of lead. Testing will be required from January 1st, 2020 to January 1st, 2023 and must be conducted every five years from the initial testing.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the director can obtain updated licensing information, new regulations, self-assessment guides and access forms. LPA advised staff of their responsibility to stay current in regards to new regulations.

Title 22 Deficiency has been cited on the attached LIC 809D. Report reviewed and discussed with director. Notice of Site Visit issued and must remain posted for 30 days. Appeal Rights also issued and discussed.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

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: SECRET GARDEN PRESCHOOL, THE	FACILITY NUMBER: 444416685
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/14/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/02/2021 Section Cited	1 2 3 4 5 6 7	Outdoor Activity Space. As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls. LPA observed ground visible in areas of the climbing structure where cushioning is required to observe a fall which poses a potential risk to children in care.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021

LIC809 (FAS) - (06/04)

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