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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710434
Report Date: 04/26/2022
Date Signed: 08/25/2022 11:02:43 AM

Document Has Been Signed on 08/25/2022 11:02 AM - 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:GEORGE MAYNE STATE PS/CHILDREN CTRFACILITY NUMBER:
430710434
ADMINISTRATOR:NANCY MORIN/M.DE LA TORREFACILITY TYPE:
850
ADDRESS:5030 N FIRST ST.TELEPHONE:
(408) 423-1717
CITY:ALVISOSTATE: CAZIP CODE:
95002
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 16DATE:
04/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Site Supervisor - Maria De La TorreTIME COMPLETED:
03:45 PM
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On Tuesday, April 26, 2022 at 12:17 pm, Licensing Program Analyst’s (LPA) Manel Estoesta conducted an unannounced Required One (1) Year Visit. LPA met with the Site Supervisor - Maria De La Torre and explained the nature of the site visit. Present on this visit were 4 staff member and 16 preschool children. The facility operates Monday to Friday from 7:30 am to 5:30 pm.

LPA toured the facility to conduct a health and safety inspection with the Site Supervisor. The Preschool Program (Children Center) is located in the George Mayne Elementary School and under the management of the Santa Clara Unified School District. The facility is licensed for Portable Classroom F2-4 (previously named A-C). The facility is only operating on F2-3 classrooms. F2 classroom has the part time preschool children from Monday to Friday 8:15 am to 11:15 am and the F3 classroom has the full-time preschool children from Monday to Friday 7:30 am to 5:30 pm. Facility follows the posting regulatory requirement. Restrooms for children to use in each room were observed to be in safe and sanitary operating conditions. There were no bodies of water observed. Site Supervisor stated that facility do not have weapons on the premises. Furniture and equipment were in good condition, free of sharp, loose, or pointed parts. The facility's elementary school cafeteria prepares and provides meals and snacks for the children.
LPA observed and reviewed the Menus. The food-preparation and storage areas were observed in clean and free of litter and rubbish and the facility have measures taken to keep all such areas free of rodents and other vermin. Floors were clean and safe, and outdoor activity space were free of hazards. Disinfectants, cleaning solutions, poisons, and other items that are dangerous to children were stored inaccessible to children. Outdoor activity space is fenced and play equipment were maintained in a safe condition and free of hazards. There were shaded rest areas for children. Drinking water is arranged to be readily available for children in care. LPA observed two outdoor locked storage shipping containers.
LPA observed a fully fire extinguisher, First Aid Kit, and smoke and carbon monoxide detectors. Fire and Disaster drill was last conducted in March 2022.
SEE 809 C.....
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: GEORGE MAYNE STATE PS/CHILDREN CTR
FACILITY NUMBER: 430710434
VISIT DATE: 04/26/2022
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Criminal background checks for staff members are managed by the Santa Clara Unified School District. The facility uses a software operation application, LPA reviewed the software operation application (Care Connect) with the Site supervisor on how it works for example but not limited to Children's Sign in and Out, Authorized Representative Communication, Enrollment Document Center and Children's Record. A sampling of facility’s children’s electronic files was selected for review and facility's Personnel Record reviewed with the Site Supervisor.

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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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



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.

LPA discussed the PIN 21-21-CCP. LPA obtained copies of the facility's Children Roster and Staff Roster. There are no deficiencies cited on this visit.


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.

Exit interview conducted and report was reviewed with the Site Supervisor - Maria De La Torre

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC809 (FAS) - (06/04)
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