274413138-9-29-2021-07-CC-FCJO-C7BS7A-20210929133715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274413138
Report Date: 09/29/2021
Date Signed: 09/29/2021 01:37:22 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 AND ANTLE EARLY LEARNING CENTER		FACILITY NUMBER:	274413138
ADMINISTRATOR:	MARIA L. BECERRA		FACILITY TYPE:	830
ADDRESS:	121 SPRECKLES BLVD		TELEPHONE:	(831) 455-9947
CITY:	SPRECKLES	STATE: CA	ZIP CODE:	93962
CAPACITY:	18	CENSUS: 5	DATE:	09/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Cristina Mireles		TIME COMPLETED:	01:50 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, conducted an unannounced annual required inspection to the Facility today. LPA met with teacher Cristina Mireles, and explained the nature of today's inspection to her. LPA observed there were five infants in care and three staff members with them. LPA observed the facility is in compliance in ratio and capacity today. LPA toured the Facility inside during today's inspection. A review of staff records on 9/22/21 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded director 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. LPA reviewed a random sample of three children's files. The Information and Emergency Information form (form LIC700) is in each children's file. LPA observed the center has updated Infant Needs and Services and feeding plan forms for each infant. Teacher Mireles and several staff have current CPR and First Aid certifications in file. Ms. Mireles understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). LPA observed that the teacher/child ratio was in compliance during today's visit. Ms. Mireles understands the conditions, limitations, and capacity specifications of the Facility license. Ms. Mireles understands that children shall be visually supervised at all times. LPA reviewed the sign-in, sign-out sheets and observed in them full parents or representatives signatures. Licensee was unable to provide a copy of the children's roster. Report dated 9/29/21 continues in 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 AND ANTLE EARLY LEARNING CENTER	FACILITY NUMBER: 274413138
	VISIT DATE: 09/29/2021

NARRATIVE

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

LPA observed that the infant care area is clean and safe for all children and staff. Drinking water is readily available for the children in each room via water dispensers. Ms. Mireles states that there are no weapons on the premises. LPA observed there are records in each personnel file documenting the educational background of the staff.

Ms. Mireles stated the center does provide food and formula to all the infants. The Center has a food preparation area equipped with sink and refrigerators, and running water. Cleaning supplies are inaccessible to the children. LPA observed a first aid kit in each classroom. Ms. Mireles stated there are not infants on medication enrolled in the center. LPA did not observe any bodies of water.

LPA discussed the requirements of AB 633 with the director and the "zero tolerance" related regulations with the Director. LPA observed that all the staff has renewed the Mandated Reporter training.

LPA referred the Site Director to the Department website: www.ccld.ca.gov. for additional information.

A type B deficiency was issued as result of today's inspection.

NOTICE OF SITE VISIT ISSUED, POST AND MUST REMAIN POSTED FOR 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 AND ANTLE EARLY LEARNING CENTER	FACILITY NUMBER: 274413138
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 care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
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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: 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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