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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354400147
Report Date: 08/03/2023
Date Signed: 08/03/2023 01:50:55 PM

Document Has Been Signed on 08/03/2023 01:50 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:LITTLE BALER PRESCHOOLFACILITY NUMBER:
354400147
ADMINISTRATOR:RHODES, RENEFACILITY TYPE:
850
ADDRESS:1520 SUNNYSLOPE ROADTELEPHONE:
(831) 637-4326
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY: 72TOTAL ENROLLED CHILDREN: 61CENSUS: 50DATE:
08/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Rene RhodesTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Deanna Villagrana met with Director Rene Rhodes to open complaint for above allegation. LPA explained the reason for the visit. LPA observed 15 children with two teachers in the kitchen area, 11 children with one teacher in the 4's room and 24 children with three teachers and two aids in the playground area.

Upon arrival, LPA observed children playing in the playground area on the left side of the building without supervision. LPA obtained a three minute video and photos of children being unsupervised. LPA observed teacher's aid Frances Jacquez does not have fingerprint clearance. Frances Jacquez began working for facility on July 17, 2023 according to Director Rene Rhodes. LPA did not observe a current roster of children.

The following type A and B deficiencies were cited on the attached page (809-D). Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

LPA Deanna Villagrana informed licensee Rene Rhodes that this report dated 08/03/2023 document(s) 2 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deanna Villagrana informed the licensee Rene Rhodes to provide a copy of this licensing report dated 08/03/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

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: Deanna Villagrana
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2023
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 08/03/2023 01:50 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 08/03/2023 at 01:12 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: LITTLE BALER PRESCHOOL
FACILITY NUMBER: 354400147

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
08/04/2023
Section Cited
CCR
101229(a)(1)

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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 Rene Rhodes will conduct a meeting with staff and have them sign meeting notes stating the understand the above regulation and submit to CCLD by POC date. This is a repeat violation within 12 months.
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This requirement was not met as evidenced by LPA observed children playing in the playground area on the left side of the building without supervision. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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Request Denied
Type A
08/03/2023
Section Cited
CCR101170(e)(1)

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Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by LPA observed teacher's aid Frances Jacquez does not have fingerprint clearance.
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Director Rene Rhodes understands Frances Jacquez be present at the facility until fingerprint clearance is obtained.
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This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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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:Mary Segura
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/03/2023 01:50 PM - It Cannot Be Edited


Created By: Deanna Villagrana On 08/03/2023 at 01:25 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: LITTLE BALER PRESCHOOL
FACILITY NUMBER: 354400147

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/10/2023
Section Cited
HSC
1596.841

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Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
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Director Rene Rhodes will submit a current roster to CCLD by POC date.
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This requirement was not met as evidenced by LPA did not observe a current roster of children. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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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:Mary Segura
LICENSING EVALUATOR NAME:Deanna Villagrana
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2023


LIC809 (FAS) - (06/04)
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