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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274414758
Report Date: 08/09/2021
Date Signed: 08/09/2021 12:56:49 PM

Document Has Been Signed on 08/09/2021 12:56 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:METZ ROAD STATE PRESCHOOLFACILITY NUMBER:
274414758
ADMINISTRATOR:ANGELA EHRLICHFACILITY TYPE:
850
ADDRESS:1303 METZ ROADTELEPHONE:
(831) 678-1581
CITY:SOLEDADSTATE: CAZIP CODE:
93960
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
08/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lori MoronesTIME COMPLETED:
01:00 PM
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On 08/09/2021 at 10:30 AM, Licensing Program Analyst (LPA), Susy Cervantes, conducted an unannounced annual visit to the Facility. LPA met with Lori Morones, program coordinator, and explained the nature of today’s visit. LPA toured the Facility both inside and outside during today’s visit. 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 Soledad Unified School District and do not come under the jurisdiction of Community Care Licensing Division. LPA reminded them of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.

LPA observed the medical assessment and the Information and Emergency Information form (LIC 700) in 5 children’s files. LPA observed the required health screening in 5 staff files. Staff have current CPR and First Aid Certifications on file (expiration date: 09/2022). Coordinator 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). Coordinator understands the conditions, limitations, and capacity specifications of the Facility license. Coordinator understands that children shall be visually supervised at all times. LPA was unable to check the sign in and out sheet since school has not started. Child Care Facility Roster (LIC 9040) was in compliance.
Continues on report dated 08/09/2021
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2021
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: METZ ROAD STATE PRESCHOOL
FACILITY NUMBER: 274414758
VISIT DATE: 08/09/2021
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Continuation of report dated 08/09/2021
LPA observed three staff cleaning and organizing the classroom. Coordinator stated children will have water bottles and they can be refilled via water dispenser located in the playground area. LPA observed solid waste containers with tight-fitting lids in the classroom and in the playground areas. Staff and 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. Coordinator stated that there are no weapons on the premises.

Food is provided by the San Vicente Elementary school, LPA observed a waiver to allow the preschool children to eat at the elementary school cafeteria. Cleaning supplies are inaccessible to the children. Medications at the Facility are stored appropriately in a locked cabinet in the classroom. LPA reviewed the Facility’s medicine log and medication lock box during today’s visit.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground areas utilized by children are surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is also sufficient resilient materials (type: poured rubber flooring) in the outdoor playground area. LPA did not observe any bodies of water.

LPA discussed Zero Tolerance with $500 civil penalty and the requirements of AB633 with coordinator, Lori Morones and provided them the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and they understands the requirements. Upon receipt, coordinator shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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

LPA conducted an exit interview with Coordinator. No deficiencies cited during today's visit. NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2021
LIC809 (FAS) - (06/04)
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