015700512-9-13-2021-52-CC-MOTI-C6TV8K-20210913161253

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 015700512
Report Date: 09/13/2021
Date Signed: 09/13/2021 04:13:05 PM

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:	SAFARI KID - IRVINGTON		FACILITY NUMBER:	015700512
ADMINISTRATOR:	KIRAN, GOWRI		FACILITY TYPE:	850
ADDRESS:	41811 BLACOW ROAD		TELEPHONE:	(408) 504-1965
CITY:	FREMONT	STATE: CA	ZIP CODE:	94538
CAPACITY:	105	CENSUS: 40	DATE:	09/13/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:57 AM
MET WITH:	Meenal Mehta		TIME COMPLETED:	04:32 PM

NARRATIVE

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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility unannounced on 9/13/2021 to conduct a Required - 1 Year inspection. LPA met with Director Meenal Mehta. Present during today's visit were 6 staff members and 40 preschool aged children. Also on site were 2 heritage staff and 12 heritage children. Preschool children and heritage children were not observed to be commingling during LPA's visit. The center currently operates from 7:00AM to 6:30PM Monday through Friday. LPA toured the facility and play yard for a health and safety inspection.

LPA reviewed staff records on 9/13/2021 at 12:48PM indicates that S1, S2, S3, S4 and S5 were missing required immunizations against (Tdap, Measles and Flu). (see 809D for deficiency) LPA reviewed (6) Personnel files were reviewed. (10) Children's files were reviewed. The classrooms and play yard are age appropriate and in good repair. Bathrooms are clean and in working order. The staff have a separate bathroom located within the facility. The sign in and out logs were reviewed and checked with current census. Outdoor play areas are free of hazards and provided a shaded area for the children and access to drinking water. There is a working telephone. Working carbon monoxide detector, smoke detector and fully charged fire extinguisher were observed at the facility. Opening and closing staff have current CPR and first aid training. LPA observed there are tight fitting lids on trash cans located inside the center. The center documents and conducts fire/disaster drills with the last one documented in 8/2021. Facility provides AM/PM snacks and children receive catered food from a vendor.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

See 809-C for second page of report....

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SAFARI KID - IRVINGTON	FACILITY NUMBER: 015700512
	VISIT DATE: 09/13/2021

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Director is reminded that unusual Incidents must be reported within 24 hours by phone. Written report is to follow within 7 days utilizing form LIC624. LPA informed the Director that all forms can be downloaded at www.ccld.ca.gov and encouraged the Director to email childcareadvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The Director was also reminded that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.

This facility provides Incidental Medical Services - IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children's, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

An exit interview was conducted with the Director, Meenal Mehta. A Type B deficiency is being cited on today's date. The Director was provided a copy of their appeal rights and the signature on this form acknowledges receipt of these rights. A Notice of Site visit was posted at the time of inspection and must remain posted for 30 days.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: SAFARI KID - IRVINGTON	FACILITY NUMBER: 015700512
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/13/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 5 out of 6 staff person's files (S1, S2, S3, S4 and S5) did not contain the appropriate documentation of being immunized against influenza, pertussis and measles which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/13/2021
	Plan of Correction
1 2 3 4	Facility representative is to ensure that all required staff persons have the appropriate immunizations on file. Copies of immunizations against influenza, measles and pertussis for S1, S2, S3, S4 and S5 to be submitted to LPA no later than 10/13/2021.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

LIC809 (FAS) - (06/04)

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