274410830-9-29-2021-07-CC-FCJO-C7BS92-20210929134000

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274410830
Report Date: 09/29/2021
Date Signed: 09/29/2021 01:40:08 PM

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:	MAOF TANIMURA & ANTLE EARLY LEARNING CENTER		FACILITY NUMBER:	274410830
ADMINISTRATOR:	MARIA L. BECERRA		FACILITY TYPE:	850
ADDRESS:	121 SPRECKELS BLVD		TELEPHONE:	(323) 890-9600
CITY:	SPRECKELS	STATE: CA	ZIP CODE:	93962
CAPACITY:	24	CENSUS: 9	DATE:	09/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Cristina Mireles		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Fermin Campos-Jaramillo made an unannounced annual required inspection to the center today. LPA met with teacher Cristina Mireles, and explained the nature of today's inspection to her. LPA observed 9 children were in care today. LPA observed 4 staff members were taking care of the children. LPA observed that at least one member of the staff has a current CPR/First Aid certifications. LPA observed the teacher-child ratio was in compliance with regulations. LPA observed posted the forms required by this Licensing Department. LPA toured the facility inside and outside. Staff and children's toilets and sinks are safe and in sanitary operating conditions. LPA observed the storage areas are clean and free of litter. LPA observed disinfectants, cleaning solutions, sharp objects, and other similar items are not accessible to children. LPA observed there is a first aid kit inaccessible to children. LPA observed posted a menu with the meals provided by the center. LPA observed the center has a food preparation area equipped with stove, refrigerator, microwave, and sink with running hot and cold water. LPA observed the facility has a functioning smoke detectors and a fire extinguisher type 3A40BC last serviced on 1/11/21. LPA observed that drinking water is readily available indoor via water dispenser and disposable cups. LPA observed there are trash cans with tight fitting covers for the disposal of solid waste. LPA observed the center has at least one working Carbon Monoxide detector. Ms. Mireles states that there are no weapons in the premises. Playground areas are surrounded with appropriate fencing and not bodies of water. LPA observed that all furniture, equipment and playground equipment is safe and in good conditions, free of sharp, loose, or pointed parts. LPA observed that shade in the playgrounds is provided by a tarp. LPA observed that outdoors water is provided via water cooler. LPA observed there are enough sand as resilient material under the climbing structures in the playground. LPA observed all floors were clean and safe. REPORT DATED 9/29/21 CONTINUES ON PAGE #2

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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: MAOF TANIMURA & ANTLE EARLY LEARNING CENTER	FACILITY NUMBER: 274410830
	VISIT DATE: 09/29/2021

NARRATIVE

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Report dated 9/29/21 continues from page 1.

LPA observed that a fire drill was documented on 8/30/21. Licensee was not able to provide a copy of the children's roster. LPA reviewed a random sample of five children's files and found in them the Identification and Emergency Information form, the Physician Report form, the Child Preadmission Health Report form, and the Parents Rights form. LPA reviewed the sign-in, sign-out sheets and are signed with full signatures. LPA observed there was a medical assessment document and a preadmission health history document in each child’s record. LPA observed there are records in each personnel file documenting the educational background of the staff.
LPA observed on the LIS report dated 9/22/21 that all the staff present has obtained a criminal records clearance or exemptions. LPA reminded Ms. Mireles of the applicable civil penalties for those adults who have not received fingerprint clearances, 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.
Teacher Mireles stated there is only one child under medication currently enrolled in the center. LPA verified the child medicine has a log of use and child's information.
LPA observed that all the staff members have renewed the mandated reporter training AB1207. LPA observed that all the staff members have proof of immunization for measles, pertussis and influenza in file in compliance with the SB792.

There was a type B deficiency cited during today's inspection.
Exit interview was conducted with teacher Mireles and Supervisor Aziz who came to the center to help out. Current director Ms. Becerra is on vacations leave. LPA provided licensee with the notice of site visit which has to be visible posted for the following 30 consecutive days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: MAOF TANIMURA & ANTLE EARLY LEARNING CENTER	FACILITY NUMBER: 274410830
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/13/2021 Section Cited	1 2 3 4 5 6 7	Current roster of children provided care in facility required. Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician.
	8 9 10 11 12 13 14	This roster shall be available to the licensing agency upon request. This requirement was not met as evidenced by: Licensee does not have a current Form 9040, (or similar with all the Lic 9040 information) available). This poses a potential risk to the children in ca	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC809 (FAS) - (06/04)

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