270710411-4-21-2023-07-CC-SCES-CR4T8E-20230421143012

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 270710411
Report Date: 04/21/2023
Date Signed: 04/21/2023 02:30:19 PM

Document Has Been Signed on 04/21/2023 02:30 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:	GREENFIELD UNION SCHOOL DISTRICT-PRESCHOOL PROGRAM		FACILITY NUMBER:	270710411
ADMINISTRATOR:	TERESA RAMIREZ		FACILITY TYPE:	850
ADDRESS:	490 EL CAMINO REAL		TELEPHONE:	(831) 674-8731
CITY:	GREENFIELD	STATE: CA	ZIP CODE:	93927
CAPACITY: 45	TOTAL ENROLLED CHILDREN: 45	CENSUS:	DATE:	04/21/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Teresa Ramirez and Erin Ramirez		TIME COMPLETED:	02:35 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	On 04/21/2023 at 12:25 PM, Licensing Program Analyst (LPA), Susy Cervantes, met with Lead teacher/Director, Teresa Ramirez, for an annual inspection and explained the nature of today's visit to them. LPA toured the Facility both inside and outside for today's inspection. LPA 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, Menus, and Activity Schedule. Facility is on an elementary school campus and has an active waiver for shared playground. Administrator, Erin Ramirez arrive during today's visit. All staff are hired and fingerprint cleared by the Greenfield Unified School District. LPA reviewed six children and three staff's files during today's inspection and observed Staff 02 is missing their health screening and Staff 03 is missing proof of vaccination against Pertussis. All staff have current CPR and first aid. Director and administrator understand that 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). LPA observed that the teacher/child ratio was in compliance during today's visit. LPA observed nineteen preschool children with three teachers at the facility. Director and administrator understand the conditions, limitations, and capacity specifications of the facility license. Director and administrator understand that children shall be visually supervised at all times. LPA observed a functioning carbon monoxide detector. LPA observed a drill log that was conducted on 02/16/23. LPA observed the facility is clean and safe for all children and staff. Drinking water is readily available for the children in each room and in the outdoor playground area via water bottles. LPA observed solid waste containers with tight-fitting lids in the facility. Children's bathrooms are clean, sanitary, and operable. There is a separate staff toilet not utilized by the children which an isolated child can use if needed. Administrator stated that there are no weapons or firearms on the premises. *Continues on report dated 04/21/2023 ______________________________________ pg. 1/2*

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

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 04/21/2023 02:30 PM - It Cannot Be Edited

Created By: Susy Cervantes On 04/21/2023 at 02:09 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: GREENFIELD UNION SCHOOL DISTRICT-PRESCHOOL PROGRAM	FACILITY NUMBER: 270710411
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in Staff 03 does not have proof or immunzation against Pertussis which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	Staff 03 will schedule an appointment to get proof of receiving vaccination for Pertussis. Administrator will send proof of scheduled appointment and once complete, a copy of proof of vaccination to the San Jose Regional Office (SJRO) by close of business on May 5, 2023.

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in which Staff 02 does not have a physician's health screening on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/05/2023
	Plan of Correction
1 2 3 4	Staff 02 will schedule an appointment to receive a health screening by a physician. Administrator will submit proof of scheduled appointment and once complete, a copy of proof of vaccination to the San Jose Regional Office (SJRO) by close of business on May 5, 2023.

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:

Mary Segura

LICENSING EVALUATOR NAME:

Susy Cervantes

LICENSING EVALUATOR SIGNATURE:

DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: GREENFIELD UNION SCHOOL DISTRICT-PRESCHOOL PROGRAM	FACILITY NUMBER: 270710411
	VISIT DATE: 04/21/2023

NARRATIVE

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Continuation of report dated 04/21/2023 ______________________________________ pg. 2/2

Food and snacks are prepared and provided by the elementary school. The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Any poisons are stored in locked storage that is inaccessible to children. Any medications at the facility are stored in a locked cabinet in the preschool room. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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: http://www.ada.gov/childqanda.htm

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. The playground canopy provides shade for the day care children. There is also sufficient resilient materials (turf and pour and play) in the outdoor playground area. LPA did not observe any bodies of water.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Type B deficiencies were cited during today's visit. Administrator was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. Exit interview conducted and report was reviewed with the administrator, Erin Ramirez. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2023

LIC809 (FAS) - (06/04)

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