274414767-5-22-2023-07-CC-CNEN-CS3STM-20230522140947

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 274414767
Report Date: 05/22/2023
Date Signed: 05/22/2023 02:09:57 PM

Document Has Been Signed on 05/22/2023 02:09 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:	OHLONE INFANT MIGRANT & SEASONAL HEAD START ROOM 1		FACILITY NUMBER:	274414767
ADMINISTRATOR:	RENTERIA, A/LETICIA G		FACILITY TYPE:	830
ADDRESS:	58 HILLCREST ROAD ROOM 1		TELEPHONE:	(831) 728-7897
CITY:	ROYAL OAKS	STATE: CA	ZIP CODE:	95076
CAPACITY:	16	CENSUS: 16	DATE:	05/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Leticia Gomez & Maria Cortes		TIME COMPLETED:	02:20 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), Cortney Nelson, met with Site Supervisor, Leticia Gomez, and Child Development Coordinator, Maria Cortes for an unannounced Required- 1 Year Inspection. LPA was granted access to the facility by staff member, Leticia, and toured both indoors and outdoors during the inspection. Upon arrival, there were fourteen (14) infants and six (6) staff members present, which is compliant with the facility license capacity and ratio requirements. An additional two (2) infants arrived during today's inspection. LPA observed all required postings near the entrance to the facility and the hours of operation for the facility are Monday – Friday, 6:00AM-6:00PM. LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log and observed the last fire/disaster drill was conducted on 5/16/2023, which is compliant with the six-month requirement. The facility has a waiver for legal guardian signature and LPA observed that all guardians have full signature this season. There is a fully charged 3A40BC fire extinguisher (last serviced: 5/2023), functioning smoke detector and carbon monoxide detector. Leticia states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. There are no weapons or firearms on the premises. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers, Section 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice 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 Indoor areas were inspected by the LPA and observed to be clean, orderly, and safe for day care infants. The infant room is physically separate from the preschool component in Room #2. Toys are safe and do not have sharp edges or small parts that may pose a choking hazard. The infant changing tables were observed to be padded, within arms reach of a sink, in good repair and safe condition. Cribs used by the infants are free from loose articles, covered with a fitted sheet, and there are no objects hanging above or attached to the crib. Cots are used for napping for infants that are already walking. The floors are clean and free of tripping hazards and waste containers have tight fitting lids.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

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: OHLONE INFANT MIGRANT & SEASONAL HEAD START ROOM 1	FACILITY NUMBER: 274414767
	VISIT DATE: 05/22/2023

NARRATIVE

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The outdoor area was inspected and observed to be fenced in and physically separated from space utilized by the preschool component. The outdoor area is divided into two play areas depending on the mobility of the infant. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (rubber padding) to absorb falls. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by canopy and there are three (3) functioning sinks located outside.

Five (5) infant files and five (5) staff files were reviewed and all required documents were present. All staff members have current CPR/First-Aid certifications and the Site Supervisor's expires 3/6/2025. The Site Supervisor has current Mandated Reporter Training that expires on 8/3/2024. LPA reminded both trainings must be renewed every 2 years.

All infants have current Needs and Services plan that has been updated quarterly. Feeding plan is current for all infants and Licensee understands that all formula and bottles provided should be labeled individually with the child’s name and the date.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

Exit interview conducted and report was reviewed with Child Development Coordinator, Maria Cortes.

As a result of today’s inspection, a deficiency was cited, see LIC809-D.

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

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/22/2023 02:09 PM - It Cannot Be Edited

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: OHLONE INFANT MIGRANT & SEASONAL HEAD START ROOM 1	FACILITY NUMBER: 274414767
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above as the facility has not submitted water lead test results that follow the written directives, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/31/2023
	Plan of Correction
1 2 3 4	The facility will submit a plan of correction that outlines when water lead testing will be completed to bring the site into compliance. LPA advised submitting prior water lead testing that has been completed, however did not meet the written directives criteria.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney Nelson	TELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

LIC809 (FAS) - (06/04)

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