480105679-10-1-2019-01-CC-MAUN-BGJR6Z-20191001124535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 480105679
Report Date: 10/01/2019
Date Signed: 10/01/2019 12:45:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME:	VUSD-CDC-FEDERAL TERRACE P/S		FACILITY NUMBER:	480105679
ADMINISTRATOR:	TRUJILLO,MARISA		FACILITY TYPE:	850
ADDRESS:	415 DANIEL AVENUE		TELEPHONE:	(707) 556-8755
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94590
CAPACITY:	30	CENSUS: 7	DATE:	10/01/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Marisa Trujillo		TIME COMPLETED:	01:00 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	An Annual/Random inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. The facility file was reviewed prior to this visit. The preschool program is located on the Federal Terrace Elementary school campus in classroom #2. The Director stated that the Vallejo Unified School District ensures that all district personnel obtain criminal record clearance, prior to working at the facility. This program is operated by the Vallejo Unified School District public agency and is a Title 5 funded program. The facility has a waiver to allow the preschool to share the bathrooms with the Federal Terrace Elementary School campus. The facility’s operating hours are 7:00am - 5:30pm, Monday-Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. LPA did not observe any poisons. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors. The children have access to drinking fountains indoors and outdoors. The children's bathrooms are in safe and sanitary condition. A current menu was posted on the refrigerator. Food prep areas are clean. Food is properly stored and refrigerated as needed. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas are in safe condition. There is wood chip cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. The Director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and seven children were being supervised by one teacher and two aides. The facility was operating within the licensed capacity. There is a working smoke detector, carbon monoxide detector and fire extinguisher rated at least 2A10BC. At least one staff member present during the visit (S1) possessed current CPR and First Aid certifications, however S2 works the closing shift and S2 does not have a current and valid Pediatric CPR and First Aid certification.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: VUSD-CDC-FEDERAL TERRACE P/S	FACILITY NUMBER: 480105679
	VISIT DATE: 10/01/2019

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
26
27
28
29
30
31
32

LPA issued an Advisory Note for this Technical Violation. Three children’s records were reviewed at 11:00am, and contained identification forms with authorized representative information. Children's records reviewed revealed that C1 and C2's transcribed PM 286 were not up to date. LPA issued an Advisory Note for this Technical Violation. The Director stated that staff records are stored off site at the VUSD District Office and LPA will review at a later time. This facility is providing Incidental Medical Services (IMS). The Department’s Incidental Medical Services (IMS) policy was discussed with the Director. The Director stated that there were currently no children's IMS medications stored on site. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the Director. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Leslie Lepori	TELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck Augustin	TELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2