274413138-6-8-2023-07-CC-FCJO-CSLQU3-20230608122805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274413138
Report Date: 06/08/2023
Date Signed: 06/08/2023 12:28:15 PM

Document Has Been Signed on 06/08/2023 12:28 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:	MAOF TANIMURA AND ANTLE EARLY LEARNING CENTER		FACILITY NUMBER:	274413138
ADMINISTRATOR:	ANNA MARIA CONTRERAS		FACILITY TYPE:	830
ADDRESS:	121 SPRECKLES BLVD		TELEPHONE:	(831) 455-9947
CITY:	SPRECKLES	STATE: CA	ZIP CODE:	93962
CAPACITY:	18	CENSUS: 3	DATE:	06/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Anna M Contreras		TIME COMPLETED:	12:40 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 Required - 1 Year Inspection. LPA met with Center Director, Anna M Contreras, and explained to her the purpose of today's visit. Facility's License, Notification of Parents’ Rights Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday 4:30 AM to 5:30 PM. The facility serves children ages 0 to 2 years old. The indoor and outdoor areas were toured. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. LPA observed diaper changing tables within arm's reach of a sink. Site Director stated that the facility has cleaning personnel that comes to the center every other day to clean the facility. Foods and beverages were kept protected against contamination and spoilage. The center provides lunch, and snacks to children. There is a kitchen at the facility for food preparation. The kitchen is equipped with refrigerator, freezer, stove, and a sink with hot and cold running water. Drinking water is available for the children indoor via water dispensers and disposable cups. LPA observed trash cans with tight fitting lids for the disposal of solid waste. There is a separate trash can with tight fitting cover for the disposal of diapers in the room. Fire extinguisher, working smoke and carbon monoxide detectors were observed. There are two sinks and two toilets available for the children. There is a separate staff bathroom next to the director's office. Site Director stated that there are no firearms in the facility. Drinking water is readily available for the children outdoor via pitchers and disposable cups. The playground is surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by a canopy and a tree. LPA observed sand as resilient material under and around the climbing structure. There were no bodies of water observed. Continuation on next pages:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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: 06/08/2023

NARRATIVE

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Report date 6/8/23 continues from page 1.

LPA reviewed 4 infant's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Physician's Report, Medical Assessment, Immunization, Infant Needs and Services Plan, and TB test.

One staff file was reviewed. Staff records reviewed include Criminal Record Statement (LIC 508), Personnel Record, Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunization (Measles, Pertussis, and Influenza), educational requirements, and required training. LPA reminded Center Director that the Mandated Reported Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

Site Director stated there are not children enrolled receiving medications. 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

LPA reviewed the safe sleep regulations with Center Director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA informed Center Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Continuation on next page:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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
	VISIT DATE: 06/08/2023

NARRATIVE

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Report dated 6/08/23 continues from page 2.

Ms. Contreras, the Center Director 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

As a result of this inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with Center Director, Anna M Contreras.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC809 (FAS) - (06/04)

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