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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270700262
Report Date: 05/24/2024
Date Signed: 05/24/2024 03:11:22 PM


Document Has Been Signed on 05/24/2024 03:11 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:CHURCH OF THE GOOD SHEPHERD PRESCHOOLFACILITY NUMBER:
270700262
ADMINISTRATOR:RACHEL CRUZFACILITY TYPE:
850
ADDRESS:301 CORRAL DE TIERRA ROADTELEPHONE:
(831) 484-2153
CITY:SALINASSTATE: CAZIP CODE:
93908
CAPACITY:64CENSUS: 0DATE:
05/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Rachel CruzTIME COMPLETED:
01:28 PM
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Licensing Program Analysts (LPAs) Andrea Cortez and Mel Matos met with Rachel Cruz, director, for an unannounced case management inspection. LPAs observed 0 preschool children in the Facility and 2 staff during today's inspection. Facility had an end of year field trip this morning and no class in the afternoon. LPAs observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. Days and hours of operation are Monday through Friday 7:30 AM to 5:30 PM. The Facility is licensed to serve a maximum of sixty four (64) children ages two to entry into first grade.

LPA reviewed six children's and two staff files (1 director) and (1 teacher) during today's inspection. Each child's file reviewed contains the required forms; including the Information and Emergency Information form (LIC 700). Both staff files reviewed contain the required forms; including transcripts/verification of experience/immunization records, and Health Screening Report. Staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. Director has CPR and First Aid certifications on file. Director understands when in operation there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). Facility provides transportation and has one teacher who picks up TK and Kindergarten children from school for after school care.

Rachel Cruz, Director, was reminded that all adults 18 and over, including employees and volunteers, 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.

Exit interview conducted and report was reviewed with the Director, Rachel Cruz. No deficiencies issued during today's inspection. A notice of site visit was given and must remain posted for 30 days
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Andrea CortezTELEPHONE: (916) 798-3658
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024
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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