430710434-10-3-2023-52-CC-MESA-CW9NHG-20231003102843

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710434
Report Date: 10/03/2023
Date Signed: 10/03/2023 10:28:49 AM

Document Has Been Signed on 10/03/2023 10:28 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 CTR		FACILITY NUMBER:	430710434
ADMINISTRATOR:	MARIA DE LA TORRE		FACILITY TYPE:	850
ADDRESS:	5030 N FIRST ST.		TELEPHONE:	(408) 423-1717
CITY:	ALVISO	STATE: CA	ZIP CODE:	95002
CAPACITY: 64	TOTAL ENROLLED CHILDREN: 64	CENSUS: 22	DATE:	10/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Maria De La Torre		TIME COMPLETED:	10:40 AM

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 Tuesday, October 3, 2023 at 8:30 am, Licensing Program Analyst’s (LPA) Manel Estoesta conducted an 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 6 staff member and 22 preschool children (10 present on half day program and 12 present on full day program). 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’s License, Parents’ Rights Poster, Personal Rights and Activity Schedules were observed to be posted. The facility is within ratio and capacity compliance today. Children were engaged in various activities under the visual supervision of the teachers. The classrooms, staff restroom, storage room, and office area were inspected. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment such as mats, cots, tables, changing tables, and chairs were age appropriate and were in god condition, free of sharp, loose, or pointed parts. Floors were clean and free from tripping hazard. The facility's elementary school cafeteria prepares and provides meals 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. Food and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on and were in good repair.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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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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: 10/03/2023

NARRATIVE

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Outdoor activity space is fenced and was inspected. The play equipment was maintained in a safe condition and free of hazards. There were no bodies of water observed. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were shaded rest areas for children. Drinking water are arranged to be readily available to children during indoor and outdoor activities.
Restrooms for children to use in each room were observed to be in safe and sanitary operating conditions.

LPA reviewed and or discussed the following;

1. Facility file which Fire and Earthquake Drills were conducted and documented on 06/14/2023 and 08/15/2023.
2. The facility utilizes a software application (MCT Care Connect) for the facility's record keeping. LPA reviewed the software application with the Director.
2. Children’s Sign in and Out Records for the day. LPA also obtained copies of the Facility's updated Personnel Report and Child Care Facility Roster.
3. Staff Files and Staff Criminal Record Clearance are being managed by the Santa Clara Unified School District.
4. Children Files. Each child’s file contains but not limited to Incident Report, Medication Record, Room Change Record, records of receipt for Parents' Rights Notice, Identification and Emergency Information, Consent for Emergency Medical Treatment form, and Immunization.
5. Facility does not provide transportation for children, but the Director understands that children cannot be left alone, unattended in park vehicles.

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

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: GEORGE MAYNE STATE PS/CHILDREN CTR	FACILITY NUMBER: 430710434
	VISIT DATE: 10/03/2023

NARRATIVE

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Directors were 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.

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/inspection-process.

In the areas that were evaluated, no deficiencies were observed at the time of the 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 Director Maria De La Torre.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC809 (FAS) - (06/04)

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