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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416983
Report Date: 10/24/2022
Date Signed: 10/24/2022 04:28:11 PM

Document Has Been Signed on 10/24/2022 04:28 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:GILROY HEAD STARTFACILITY NUMBER:
434416983
ADMINISTRATOR:EVA SUAREZFACILITY TYPE:
850
ADDRESS:9300 WREN AVENUETELEPHONE:
(669) 212-8692
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 25DATE:
10/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:49 AM
MET WITH:Martha MoralesTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Martha Morales, Site Director, and explained the reason for the inspection. Present during the inspection were 25 children and seven (7) staff. Facility was within ratio during today's inspection. Facility is on the Santa Clara County Office of Education: South County Annex in Room K-1 and Room K-2.

There is an area to post required postings, such as license, parent's rights, personal rights, car seat law, and menu. There is working phone at the facility. The hour of operation are Monday through Friday 8AM to 4:45PM. Facility uses electronic sign in/out. LPA reviewed sign in/sign out.

LPA toured the inside and outside of the facility. The floor was clean and free of tripping hazard. LPA observed that the cabinets for cleaning supplies had the sliding cabinet locks. LPA also observed that there were packs of disinfectant wipes. Director moved cleaning supplies and wipes to a shelf which is inaccessible to children. LPA discussed with Director that cabinets with cleaning supplies need to have a lock on it. LPA also discussed with Director that anything that states to keep out of reach of children needs to be inaccessible. LPA also observed a staple gun in the K-2 in one of the bottom cabinets. Director moved staple gun to a higher shelf where it is accessible to children. There are toys and equipment for children. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last disaster drill was conducted on 10/20/2022. Director stated that there are no weapons, such as firearms, stored on the premise.
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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2022
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GILROY HEAD START
FACILITY NUMBER: 434416983
VISIT DATE: 10/24/2022
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The outside area is fenced. Area around play structure has resilient material. Shaded rest area is provided through building overhang. There were no bodies of water observed during today's inspection.

All meals and snacks are prepared by a third party. There is an area to store food. Facility has food warmers and refrigerators to store food. Drinking water is provided through water coolers and cups.

Facility does provide Incidental Medical Services. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see PIN 22-02-CCP. 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

A copy of the facility roster was obtained. Eight (8) children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and immunization records. LPA discussed with Family Advocate about ensuring the facility names on forms are correct.

Four staff files were reviewed. The records reviewed include but not limited to education credit or permits, Mandated Reporter training certificate, and immunization records. There is at least one staff with a valid CPR/1st Aid, which expires on 03/26/2024.

All staff are fingerprinted through Santa Clara County Office of Education. Therefore, all criminal records are monitored through the Santa Clara Country Office of Education.

As a result of this inspection, a technical violation was issued. Exit interview was conducted and report was reviewed with Site Director Martha Morales. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC809 (FAS) - (06/04)
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