430700961-11-14-2019-07-CC-TDON-BHX2GP-20191114162328

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430700961
Report Date: 11/14/2019
Date Signed: 11/14/2019 04:23:36 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:	ACTION DAY NURSERY ON PRUNERIDGE		FACILITY NUMBER:	430700961
ADMINISTRATOR:	SARAH HOLLOWAY		FACILITY TYPE:	850
ADDRESS:	2001 PRUNERIDGE AVENUE		TELEPHONE:	(408) 244-2909
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95050
CAPACITY:	68	CENSUS: 52	DATE:	11/14/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Sarah Holloway		TIME COMPLETED:	04:30 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 Analysts (LPAs) Tuoc Doan and Stephanie Collins conducted an unannounced Annual inspection of the Preschool and its Toddler Component. LPAs met with Director Sarah Holloway and informed her the purpose of the visit. Facility's License, Notification of Parents’ Right Poster, Children's Personal Rights, and Child Car Seat Law were observed to be posted. Operating days and hours are Monday-Friday 06:30 AM to 06:00 PM. Facility currently holds one active waiver granted to commingle the toddlers and preschool children in the early morning. The stipulations of the waiver were reviewed with Director. LPAs inspected the building inside and out. The Toddler Component is located in Room 2. Rooms 1 and 2, and the Office are located in the front of the property. Rooms 3 and 4, and the Dance Room are located in a detached building in the back of the property. The Preschool and Toddler rooms, restrooms, Office, Storage area, and Kitchen were inspected. Furniture and equipment were observed to be age appropriate and in good condition. Restrooms for children to use were observed to be in operating conditions. Floors were clean. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Facility provides two snacks a day. Food for lunch are packaged and prepared off site at Action Day Primary Plus Amber location. Menu was posted. Trash can for solid waste had tight fitting covers on. Outdoor activity space was enclosed by fence. LPAs observed play equipment were maintained in a good condition, free of hazards. Toddler Program's outdoor activity space is separated from the Preschool outdoor space. Areas around and under high climbing equipment were cushioned with material that absorbs falls. There were no bodies of water observed. Director stated that facility does not have weapons on the premises. Drinking water was arranged to be readily available to children. Shade is provided by trees and canopy. First Aid kit was inspected. LPAs observed that facility has Smoke and Carbon Monoxide Detectors, and fire alarm pull station. Fire Extinguishers were last serviced on 09/2019. Fire/disaster drill log recorded that the last drill was conducted on 10/07/19. Licensee provides transportation service to children. LPAs reminded Licensee that children cannot be left in parked vehicles unattended at any time.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 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: ACTION DAY NURSERY ON PRUNERIDGE	FACILITY NUMBER: 430700961
	VISIT DATE: 11/14/2019

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
26
27
28
29
30
31
32

In addition, the motor vehicles used to transport children shall be maintained in safe operating conditions, and all vehicle occupants must be secured in an appropriate restraint system.

LPAs reviewed facility's roster, and electronic sign in/out ("SmartCare") procedure and record. A sampling of children and staff files was selected for review. Children records reviewed includes Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, immunization, and Needs and Services Plan for children under 24 months. Staff records reviewed include Criminal Record and Child Abuse Index Background Check Clearance, Health Screening Report with TB Clearance, Immunization Record for Measles and Pertussis, Education Qualification, and required Training. LPAs reminded Director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one person with current Pediatric CPR/1st Aid Certification present at the facility during LPA's inspection. LPA 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. For an initial violation, civil penalty amounts to $100.00 per person up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

Facility's Incidental Medical Services (IMS) policy was discussed with Director. Director stated that currently the facility does not have children in care who requires administration of medication. 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.
LPAs also reviewed with Director the violations that would result in an immediate $500 civil penalty assessment. Facility is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations etc. Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.

In the areas that were evaluated, one regulatory violation was observed at the time of the inspection. Exit interview was conducted where this report, the violation, plan of correction, and appeal rights were reviewed with Director.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

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: ACTION DAY NURSERY ON PRUNERIDGE	FACILITY NUMBER: 430700961
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/14/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/21/2019 Section Cited	1 2 3 4 5 6 7	SIGN IN AND OUT. The person who brings the child to, and removes the child from, the center shall sign the child in/out. This requirement is not met as evidenced by: Based on LPAs' audit of today's (11/14/19) Sign In/Out record, Licensee failed to ensure that 8 children who are present during the
	8 9 10 11 12 13 14	inspection are signed in. This poses a potential risk to the health & safety of children in care.	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: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3