Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404912
Report Date: 12/19/2017
Date Signed 12/19/2017 03:38:29 PM

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:ROSEMARY PRESCHOOLFACILITY NUMBER:
434404912
ADMINISTRATOR:IGNACIO, MYLENEFACILITY TYPE:
850
ADDRESS:401 WEST HAMILTON AVENUETELEPHONE:
(408) 341-7127
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:189CENSUS: 104DATE:
12/19/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Mylene IgnacioTIME COMPLETED:
11:00 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
Licensing Program Analyst (LPA), Stephanie Rangel, conducted an unannounced random inspection to the Facility today. LPA met with assistant director Mylene Ignacio and explained the nature of today's inspection to her. 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), Menus, and Activity Schedule.

Clearances for individuals at this facility who require caregiver background checks are issued by the State Department of Education and County office of Education and do not come under the jurisdiction of Community Care Licensing Division.

Sign in and out sheet reviewed. LPA reviewed 10 children's and 4 staff files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). The staff files reviewed contains the required transcripts/verification of experience and are in compliance with SB792. Assistant director has current CPR and First Aid certifications on file. Assistant 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).

LPA observed that the teacher/child ratio was in compliance during today's inspections. Assistant director understands the conditions, limitations, and capacity specifications of the Facility license. Assistant director understands that children shall be visually supervised at all times.

REPORT CONTINUED ON THE FOLLOWING PAGE PAGE #2
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 205-9167
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2017
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: ROSEMARY PRESCHOOL
FACILITY NUMBER: 434404912
VISIT DATE: 12/19/2017
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
26
27
28
29
30
31
32
LPA observed that all rooms are clean and safe for all children and staff. LPA observed solid waste containers with tight-fitting lids throughout the Facility. Children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Assistant director states that there are no weapons or firearms on the premises.

The food preparation and storage areas are clean. All food and beverages that require refrigeration are stored in covered containers. Cleaning supplies are stored on high shelves in the kitchen area, away from children. Any poisons are stored in the locked storage area. Any medication(s) at the Facility will be stored inaccessible to children in the classrooms.
LPA observed all furniture and equipment is 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 and in the outdoor playground area via water coolers, personal water bottles, drinking fountains or pitchers/disposable cups. There is sufficient resilient materials in the outdoor playground area.
LPA did not observe any bodies of water.

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

As a result of today's inspection, no deficiencies cited.



Licensing Forms, Title 22 Regulations and information can be obtained through the internet at www.cdss.ca.gov.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 205-9167
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2