Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430701596
Report Date: 04/26/2018
Date Signed 04/26/2018 09:16:13 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:SHERRIE ROSE MAYLEFACILITY TYPE:
850
ADDRESS:528 HARRISON STREETTELEPHONE:
(408) 866-7223
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:26CENSUS: 0DATE:
04/26/2018
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Sherrie Rose MayleTIME COMPLETED:
09:30 AM
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LPA met with director Sherrie Rose Mayle and explained the nature of today's inspection to her. LPA arrived at the facility to conduct a case management inspection for the incident that required a 12/21/17 office visit. During today's inspection, LPA also conducted an annual inspection. LPA toured the Facility both inside and outside during 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 (PUB 269), snack Menus, and Activity Schedule.

In order to maintain compliance, Sherrie Rose has changed parent orientation 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. Director verbally reminds 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.
A review of staff records indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA reviewed five children's files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). Director has current CPR and First Aid certifications on file. Director understands 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). Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CAMPBELL PARENTS PARTICIPATION PRESCHOOL
FACILITY NUMBER: 430701596
VISIT DATE: 04/26/2018
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Report continued from previous page:

Solid waste containers with tight-fitting lids are throughout the Facility. Children's bathroom is clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated sick child can use if needed. Director states that there are no weapons or firearms on the premises.

The food preparation and storage areas are clean. The kids do not have lunch but they have snack, the school is operating a half day program. All food and beverages that require refrigeration are stored in covered containers. Cleaning supplies are stored on high shelves, away from children. Medication(s) at the Facility will stored on high shelves in the kitchen away from the children. LPA observed all furniture, rooms and equipment are 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. Drinking water is readily available for the children in the Facility via water cooler and disposable cups and in the outdoor playground area via water fountain. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient materials in the outdoor playground area. LPA did not observe any bodies of water.

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

No deficiencies cited today.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2018
LIC809 (FAS) - (06/04)
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