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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444416685
Report Date: 03/30/2022
Date Signed: 03/30/2022 02:08:16 PM


Document Has Been Signed on 03/30/2022 02:08 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:SECRET GARDEN PRESCHOOL, THEFACILITY NUMBER:
444416685
ADMINISTRATOR:ALYSSA NUNEZFACILITY TYPE:
850
ADDRESS:26 FLORIDO AVENUETELEPHONE:
(801) 652-4417
CITY:LA SELVA BEACHSTATE: CAZIP CODE:
95076
CAPACITY:39CENSUS: 25DATE:
03/30/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Alyssa NunezTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA), Cortney Nelson, conducted unannounced Case Management visit in regards to self-reported unusual incident that occurred on 3/9/2022. LPA was admitted into the facility by Site Director, Alyssa Nunez, and LPA explained purpose of the visit. Upon arrival there were 8 staff and 25 children present.

LPA reviewed 2 children's files and ouch reports (via paper files and Procare). Interview was conducted with Site Director and additional resources were discussed regarding playground safety standards. (Consumer Product Safety Commission Publication- Handbook for Public Playground Safety). Specifically discussed were section 5.3.6 Slides, 5.3.6.2 Slide Platform, 5.3.6.3.4 Straight Slides, and 5.3.6.4 Chute Exit Region. LPA let Site Director know that PDF of resource will be emailed for her review.

As previously discussed during Case Management visit on 3/21/2022, a final decision for any playground modifications for safety will be submitted to Licensing by 4/21/2022.

Exit interview conducted with Site Director, Alyssa Nunez.

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.

SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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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