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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483007424
Report Date: 06/10/2019
Date Signed: 06/10/2019 04:23:56 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:MUSTARD SEED PRESCHOOLFACILITY NUMBER:
483007424
ADMINISTRATOR:NOGALIZA, DANNIELLEFACILITY TYPE:
850
ADDRESS:901 SOLANO AVE.TELEPHONE:
(707) 557-7923
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:42CENSUS: 18DATE:
06/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Danielle Nogaliza-DirectorTIME COMPLETED:
04:40 PM
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An Annual/Random inspection was made to the facility by Licensing Program Analyst (LPA), Melchisedeck Augustin. The facility file was reviewed prior to this inspection. A review of the personnel report on 06/10/19 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The preschool program has a combination toddler component and a waiver for the preschool to share the outdoor play space with the toddler program is on file. This program is not a Title 5 funded program.

The facility’s operating hours are 8:30am to 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 were clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors near the sink and outdoors. There is a drinking fountain on the playground. The children’s bathrooms were in safe and sanitary condition. A current menu was posted on the parent board. The center provides a morning and an afternoon snack; and children bring their own lunch. Food prep areas are clean. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is foam padded 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 there were 18 children were being supervised by two teachers.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019
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: MUSTARD SEED PRESCHOOL
FACILITY NUMBER: 483007424
VISIT DATE: 06/10/2019
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The facility was operating within the licensed capacity. At least one staff member present during the visit (S1) possessed current CPR and First Aid certifications. Five children’s records were reviewed at 3:11pm, and contained identification forms with authorized representative information, as well as medical assessments. Three staff records were reviewed at 3:20pm, and contained health screening forms. The sign in/out procedure was reviewed and in compliance. This facility is providing Incidental Medical Services (IMS) to children. The Department’s IMS policy was discussed with the Director. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records and LPA observed one Epipen had a current and valid prescription label. 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. LPA requested a Plan for Providing IMS from the Director. 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 LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2019
LIC809 (FAS) - (06/04)
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