Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430701596
Report Date: 12/21/2017
Date Signed 12/21/2017 10:16:18 AM

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:CAMPBELL PARENTS PARTICIPATION PRESCHOOLFACILITY NUMBER:
430701596
ADMINISTRATOR:MONICA GRODINFACILITY TYPE:
850
ADDRESS:528 HARRISON STREETTELEPHONE:
(408) 866-7223
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:26CENSUS: 0DATE:
12/21/2017
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:47 AM
MET WITH:Sherrie Rose MayleTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA), Stephanie Rangel, and Licensing Program Manager (LPM), Timetra Faulcon, met with Director Sherrie Rose Mayle at the San Jose Regional Office today for a scheduled informal meeting. The purpose of the informal meeting was to discuss the deficiencies listed below:

1) Type A deficiency issued 10/19/17 for care and supervision because Facility self-reported on two separate incidents, a child entering and using the bathroom unsupervised.

2) Type A deficiency issued on 9/13/17 for care and supervision because four children were left in the book room without visual supervision.

The Facility has completed/submitted all Plans of Correction (POC) for the above noted deficiencies. Parent orientation has been changed in length to include an emphasis on supervision when transitioning from the 2 year old class to the 3 year old class. The orientation will also include hands on training. Parents that are enrolled mid-year will receive a lengthy one on one orientation from the director. The Facility also sent an emailed reminder to parents/volunteers working in the school, regarding active supervision of children in the classroom. Job cards that show what volunteers will be working on in their station, have been updated to include specific areas that the volunteers need to supervise.

LPM explained during the meeting that if there are continued deficiencies cited for the issue noted on this report, the Facility may be referred to legal for possible administrative action, which could include revocation of the Facility license. The Facility will be monitored more frequently to ensure compliance with the Department regulations. LPM discussed the requirements of AB 633 and provided the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and they understand the requirements.
The Licensee must provide copies of this report to parents/guardians of children in care at this Facility and to parents/guardians of children newly enrolled at this Facility during the next 12 months.
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 205-9167
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2017
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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