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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408938
Report Date: 09/08/2022
Date Signed: 09/08/2022 03:09:04 PM

Document Has Been Signed on 09/08/2022 03:09 PM - 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:MY SPANISH VILLAGE IIFACILITY NUMBER:
073408938
ADMINISTRATOR:PEREZ, GLADYSFACILITY TYPE:
840
ADDRESS:1601 MARY DRIVETELEPHONE:
(925) 286-4382
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/08/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Gladys PerezTIME COMPLETED:
03:30 PM
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A Prelicensing Visit was conducted today by Licensing Program Analysts (LPAs), Melissa Domantay and Melissa Guirit. LPAs met with Applicant Gladys Perez . The applicant submitted an application for a school age license. A health and safety inspection was conducted inside and outside. The center has also applied for a preschool age program. The school age program will operate in 2 classrooms, Monday to Friday from 7:00am-6:00pm. The measurements are as follows:

INDOORS: 851.10 square feet = 24 children
OUTDOORS : 16,098.63 square feet = 214 children
The facility is awaiting a fire clearance.

LPAs observed that the classrooms has sufficient lighting and appears to be clean and in good condition. LPAs observed an ample supply of age appropriate activities, equipment and furniture. The facility has 4 sinks and 3 toilets that school age children can utilize. The building has fully charged 2A10BC fire extinguishers in each classroom, working fire alarm and carbon monoxide detector, and first aid supplies. There is a working telephone at the center. LPAs did not observe any hazardous items that would be accessible to children. Children will utilize personal reusable water bottles, with water still accessible to children inside and outside. Facility will provide snacks and lunch for children. Facility will utilize electronic sign in/out.

LPAs observed the outdoor play yards, which are fully fenced. LPAs observed two play structures which can be utilized by school age children. There is sufficient cushion to absorb a child's fall under the play structure and play areas. LPAs observed ample amount of shade for children.

See 809-C for continuance.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: MY SPANISH VILLAGE II
FACILITY NUMBER: 073408938
VISIT DATE: 09/08/2022
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The isolation area will be in the Director/Staff office for ill children.

Marta Mejia De Morazan is considered a qualified Director, with current CPR/First Aid, preventative health and safety with lead poisoning training, and mandated reporter training completed.

If this facility plans to provide Incidental Medical Services – IMS. A 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.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. LPAs reviewed responses and provided technical assistance including postings. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

School age license is pending for a capacity of 14 school age children awaiting fire clearance, There are no deficiencies being cited today. A Notice of Site inspection was provided to Applicant Gladys Perez, an exit interview was conducted.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
LIC809 (FAS) - (06/04)
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