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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010211776
Report Date: 08/26/2019
Date Signed: 09/09/2019 10:15:05 AM

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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:HIS GROWING GROVEFACILITY NUMBER:
010211776
ADMINISTRATOR:TASKER-DILL, KANDIFACILITY TYPE:
830
ADDRESS:2490 GROVE WAYTELEPHONE:
(510) 581-5088
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY:24CENSUS: 17DATE:
08/26/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kandi Tasker- DillTIME COMPLETED:
03:30 PM
NARRATIVE
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This is an amended report from 08/26/19. On 08/26/19, Licensing Program Analyst Briana Plumboy and Melissa Guirit met with Director Kandi Tasker-Dill for an Unannounced Random Inspection. The center and playground were toured to conduct a Health and Safety Inspection. Present for this visit was 8 infants, 9 toddlers, and 8 fingerprint clear and associated teachers. There is also a preschool component associated with the center, #010211775.

The infant component of the center is located inside room 1 which is divided by mobile and non-mobile infants. The mobile toddlers are on the left side of the classroom and the non mobile infants are on the right side of the classroom. The room appears to be safe, clean, and in good repair. There is adequate furniture, equipment, and toys which are age appropriate and appear to be in good condition. LPA Briana Plumboy did not observe any equipment that is prohibited inside the infant classroom. The indoor activity area is physically separate then the sleeping area. There is infant napping equipment available. LPAs observed 2 infants asleep on mattresses in the infant activity area. There are no pools, spas, hot tubs, or free standing water accessible to children during today's inspection. The menu is posted in a visible location, and is dated at least one week in advance. The changing table is in arms reach of the sink. LPA Plumboy inspected the changing area for cleanliness. The playground surface appears to be maintained. The playground equipment has age appropriate toys and equipment, with sufficient cushioning underneath to absorb a fall. LPA did not observe any dangerous items accessible today, including medications, poisons, disinfectants or cleaning supplies, that could be dangerous to infants. All solid waste containers have tight fitting covers on, and appear to be in good repair. Disaster drills are being conducted at least once every 6 months, and the log indicates the last one done was on 07/29/19.
All required documents are visible and posted for public review. The center is in compliance with the sign in and out procedure. The center is equipped with a fully stocked first aide kit, carbon monoxide, working telephone, a pull down fire alarm, and a fire extinguishers. The center is providing Vitamin D/ Whole Milk to the toddlers. See 809-C for continuance
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: HIS GROWING GROVE
FACILITY NUMBER: 010211776
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2019
Section Cited

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The sleeping area for infants shall be physically separate from the indoor activity space. This separation shall be accomplished as specified in (b) above.
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This requirement is not being met as evidence by: LPAs observed 2 infant's asleep on matresses inside the indoor activity space. This poses a potential risk to the health and safety of children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.


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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: HIS GROWING GROVE
FACILITY NUMBER: 010211776
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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 STE 1102
OAKLAND, CA 94612
FACILITY NAME: HIS GROWING GROVE
FACILITY NUMBER: 010211776
VISIT DATE: 08/26/2019
NARRATIVE
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Staff files contain mandated reporter training certificates. At least one opening/closing staff member has a current CPR/First Aid certificate.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

California Law requires Family Child Cares licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented.

Licensee is reminded that ALL assistants, volunteers, and staff, that are 18 years of age or older must be fingerprint cleared and associated to this facility prior to being in the presence of children in care or an immediate civil penalty will be assessed from $100 to $3000 per person, per incident. Licensee was reminded of the responsibility as a mandated reporter. All forms can be downloaded at www.ccld.ca.gov



LPA Plumboy provided a copy of Safe Sleep in Child Care brochure, a handout "What Does A Safe Sleep Environment Look Like?," and PIN 19-06-CCP to the licensee

See 809-D for deficiency cited today. This report shall remain on file for 3 years. A notice of site visit was given and must remain posted for 30 days. Appeal rights discussed and provided. Exit interview conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4