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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 270710411
Report Date: 04/14/2021
Date Signed: 06/03/2021 10:23:08 AM

Document Has Been Signed on 06/03/2021 10:23 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GREENFIELD UNION SCHOOL DISTRICT-PRESCHOOL PROGRAMFACILITY NUMBER:
270710411
ADMINISTRATOR:TERESA RAMIREZFACILITY TYPE:
850
ADDRESS:490 EL CAMINO REALTELEPHONE:
(831) 674-8731
CITY:GREENFIELDSTATE: CAZIP CODE:
93927
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/14/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Dr. Limary Gutierrez, Program DirectorTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Dung Mac conducted a Tele-Case Management inspection via video conference call with Director Dr. Limary Gutierrez. The tele-inspection is in response to facility’s request to increase the capacity from 24 to 72 by adding Room 38 to their existing license. The program serves children ages 3-5 years. LPA noted that the Facility is located on the Mary Chapa Elementary School campus. An approved of fire clearance from Greenfield Fire Protection District was received on 2/24/2021.

During today’s video conference call, Rooms 26 and 38 were measured by Director Dr. Gutierrez and a facility staff as LPA observed the process and provide direction over the video call.

Indoor Activity Space:
Room 38: (31.250 x 30.083) minus (encumbered) (8.917 x 11.417)
+ (3.750 x 1.917) + (7.833 x 24.000) (encumbered) = 643.10

Room 26: (37.583 x 29.667) minus (encumbered) (4 x 1.083) + (20.167 x 1.083)
+ (6.167 x 2.082) + (3 x 2.417) + (2.708 x 2.416) = 1,062.16

TOTAL INDOOR ACTIVITY SPACE:
1,705.26 sq. ft. divided by 35 sq. ft / child = 48 Preschoolers

There are 3 sinks (45), and 3 toilets (45) available for the children to use. Only cold water is available in the children's sinks. There are 2 bathrooms on premises for staff to use. Facility has a designated room where a child(ren) can be isolated if exhibiting signs of illness. There are 18 tables, 47 chairs, and 40 cubbies. LPA observed First Aid kit in both rooms, inaccessible to the children.

Report Continued on Page 2
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GREENFIELD UNION SCHOOL DISTRICT-PRESCHOOL PROGRAM
FACILITY NUMBER: 270710411
VISIT DATE: 04/14/2021
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Outdoor Measures: 138 x 55 = 7,590.000

TOTAL OUTDOOR SPACE: 7,590.000 sq. ft. divided by 75 = 101 children

LPA observed that playground is surrounded by appropriate fencing and exclusively for Preschool children. There are resilient materials (artificial grass) under and around the play structure. Shades are provided by canopy. No storage and bodies of water were observed during today’s tele-inspection.

LPA advised Dr. Gutierrez that due to the current Covid-19 pandemic and "Shelter In Place" Order, the Evaluation Report will be emailed to her (email: lgutierrez@greenfield.k12.ca.us) with "Read Receipt" notification. Dr. Gutierrez understands that her reply to the email will serve as acknowledgement that the report was received.

LPA conducted an exit Interview and advised Dr. Gutierrez that a license for 45 Preschool children will be submitted for the final stage of review by Licensing Management upon receiving of the acknowledgement of today's report.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021
LIC809 (FAS) - (06/04)
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