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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700961
Report Date: 05/13/2021
Date Signed: 05/18/2021 08:33:48 AM

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 PRUNERIDGEFACILITY NUMBER:
430700961
ADMINISTRATOR:SARAH HOLLOWAYFACILITY TYPE:
850
ADDRESS:2001 PRUNERIDGE AVENUETELEPHONE:
(408) 244-2909
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:68CENSUS: 58DATE:
05/13/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:Sarah HollowayTIME COMPLETED:
03:15 PM
NARRATIVE
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On 5/13/2021 Licensing Program Analysts (LPA) Pete Hernandez conducted an unannounced Case Management -Other of the Preschool and its Toddler Component. Due to the Covid-19 pandemic the inspection was conducted teleconference. LPA met with Director Sarah Holloway and informed her the purpose of the visit. 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.

The LPA observed that the Toddlers are being commingled with the Preschoolers all day in classroom 2.. This was discovered through interviewing of several staff and reviewing facility documentation. The waiver stipulates that the two age groups can only share space briefly in the morning until 7:30am.

A deficiency is being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC9099D. An exit interview was conducted by Video Conference, and Plan of Corrections was reviewed and developed with the licensee. A copy of this report and appeals rights were discussed and provided to the Licensee by email, Sarah Holloway, as proof this form has been confirmed received by "return receipt" of these documents due to Covid-19 shelter in place orders.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
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: ACTION DAY NURSERY ON PRUNERIDGE
FACILITY NUMBER: 430700961
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/28/2021
Section Cited

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101175(a) Waivers and Exceptions for Program Flexibilit: Unless the licensee receives prior written departmental approval for a waiver or an exception as specified in (b) below, the licensee shall maintain continuous compliance with all licensing regulations. This requirement has not been met as evidenced by:
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LPA Hernandez observed that the conditions of the waiver were not being observed by the facility. Waiver allowed toddlers and preschoolers to share space until 7:30am. The toddlers and preschoolers have been commingled for the entire day. This poses a potential risk to the health and safety of the children in care.
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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: Sandy KnightTELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2021
LIC809 (FAS) - (06/04)
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