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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270700474
Report Date: 09/04/2024
Date Signed: 09/04/2024 04:24:08 PM

Document Has Been Signed on 09/04/2024 04:24 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:NORTHMINSTER PRESBYTERIAN PRESCHOOL/KINDERPREPFACILITY NUMBER:
270700474
ADMINISTRATOR/
DIRECTOR:		JERRIANNA HAGIOFACILITY TYPE:
850
ADDRESS:315 EAST ALVIN DRIVETELEPHONE:
(831) 449-5676
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 24DATE:
09/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Jerrianna HagioTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Larios conducted unannounced Case Management inspection and met with Director Jerrianna Bigham. Purpose of today's inspection discuss an unusual incident that Director Jerrianna Hagio self reported to the Department on August 21, 2024.

LPA obtained copies of pertinent information and conducted interview during today's inspection.
On August 21, 2024 a child (C-1) uses a toddler chair to jumped over the fence staff (S-1) was not aware until another child (C-2) informed staff (S-1) child (C-1) had jumped over fence. A good samaritan walking in the sidewalk found child (C-1) and redirected to staff (S-1) in the outdoor play area.

The following "Type A" deficiency was cited and is noted on the attached page (LIC 809-D)

LPA discussed the requirements of AB633 to Jerrianna and provided a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and understands the requirements. LPA conducted an exit interview with the Director Jerrianna Hagio where this report was reviewed and copy of appeal rights was provided. Please refer to page 809-D for citation, description, and plan of correction.

A Notice of Site Visit has been issued and must remain posted for 30 consecutive days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
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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Document Has Been Signed on 09/04/2024 04:24 PM - It Cannot Be Edited


Created By: Elizabeth Larios On 09/04/2024 at 03:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: NORTHMINSTER PRESBYTERIAN PRESCHOOL/KINDERPREP
FACILITY NUMBER: 270700474

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).Supervision shall include visual observation.
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Director agreed to submit a written Plan of Correction (POC) to LPA indicating what steps will be implemented to ensure that the day care & preschool children are supervised at all times and conducted staff training, by POC due date.
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This requirement was not met as evidenced by: On 8/21/2024 a child (C-1) uses a toddler chair to jumped over the fence staff (S-1) was not aware until another child (C-2) informed staff (S-1) child (C-1) had jumped over fence. A good samaritan walking in the sidewalk found child (C-1) and redirected to staff (S-1) in the outdoor play area. This poses an immediate threat to the health and safety of children in care.
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According to AB 633, parents must be provided with this report which contains this Type A deficiency for the next 12 months and copy of signed acknowledgement form must be kept in each child's file.

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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:Joel Segura
LICENSING EVALUATOR NAME:Elizabeth Larios
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024


LIC809 (FAS) - (06/04)
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