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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415586
Report Date: 06/16/2021
Date Signed: 06/17/2021 08:13:46 AM

Document Has Been Signed on 06/17/2021 08:13 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:KING CITY EARLY EDUCATION & CHILD CARE CENTERFACILITY NUMBER:
274415586
ADMINISTRATOR:FANNY CHAVEZFACILITY TYPE:
850
ADDRESS:525 N. RUSS STREET, ROOMS 6&7TELEPHONE:
(831) 202-1230
CITY:KING CITYSTATE: CAZIP CODE:
93930
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
06/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Maria RodriguezTIME COMPLETED:
11:40 AM
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On 06/16/2021 at 9:45 AM, Licensing Program Analyst (LPA) Susy Cervantes, met with center director, Maria Rodriguez, for an annual inspection. Present were 6 staff and no children. The facility will be closing for the summer, last day children attended was 06/09/2021, facility will be closing on Friday, 06/18/2021. Days and hours of operation are Monday-Friday, 7:00 AM - 5:00 PM.

LPA toured inside and outside of the facility, rooms 6 and 7. LPA observed no bodies of water, wall heaters, or stairs. Cleaning supplies were stored in a top cabinet in the children's bathroom which is inaccessible to the children. LPA observed all required postings in both classrooms, including menu and schedule. Drinking water is available in each classroom as well as outdoors through drinking fountains and water dispensers. LPA observed play equipment to be in good working condition. Smoke/fire alarm and carbon monoxide detectors are operable. LPA observed 2A10BC fire extinguishers in both classrooms. Trash bins all have appropriately fitting covers. On 06/14/2021, LPA printed the facility personnel report and it shows that all adults that need a fingerprint clearance have obtained one. LPA reviewed 3 teachers files, all files had needed immunizations, TB testing, health screening, current CPR and first aid, as well as mandated reporter training. LPA reviewed 3 children's files and observed Identification and Emergency Information (LIC 700) as well as Child's preadmission Health Evaluation- Physician's Report (LIC 701) in each file. LPA took a picture of the current roster.

LPA conducted an exit interview with center director and reminded them of the civil penalties for not correcting deficiencies, $100 per day that the deficiency is not corrected. No deficiencies were cited during today's visit. LPA informed director that their notice of site visit will be emailed to them and must be posted for 30 days. This is a copy of Facility Evaluation Repot that was hand written and given to director on 06/16/2021 due to system freezing on computer. This report, appeal rights, and notice of site visit have been emailed to director on 06/16/2021.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2021
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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