430701365-2-22-2023-07-CC-MMOO-CPAVDP-20230222152103

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430701365
Report Date: 02/22/2023
Date Signed: 02/22/2023 03:21:10 PM

Document Has Been Signed on 02/22/2023 03:21 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:	VILLAGE LITTLE		FACILITY NUMBER:	430701365
ADMINISTRATOR:	SPILLAR, AMY		FACILITY TYPE:	850
ADDRESS:	10100 N STELLING ROAD		TELEPHONE:	(408) 438-3029
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	120	CENSUS: 59	DATE:	02/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Amy Spillar, David Desagun & Marti Eccles		TIME COMPLETED:	03:35 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) Marilou Monico and Ashley Lopez conducted an unannounced Required - 1 Year Inspection. LPAs met with Site Director, Amy Spillar, Operations Manager, David Desagun, and Admin Director, Marti Eccles, and explained the purpose of today's visit. Facility's License, Notification of Parents’ Right 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 08:00 AM to 5:00 PM. The Preschool Program utilizes eight classrooms: Rooms 17 thru 24 and Kirkish Hall. The facility serves children ages 2 years old to entry into 1st grade. LPAs toured the indoor and outdoor areas. LPAs 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. The facility is clean. The staff and children's bathrooms are clean, sanitary, and operable. Amy stated that the facility has third party cleaning service that comes after daycare hours to clean the facility. The center provides lunch, morning and afternoon snacks to children. There is a kitchen at the facility for food preparation. The kitchen is equipped with refrigerator, microwave, ovens, stove, dishwashers, and sinks with hot and cold running water. Foods and beverages were kept protected against contamination and spoilage. Drinking water is available for the children indoor via pitchers and cups and individual water bottles. LPAs observed trash cans with tight fitting covers for the disposal of solid waste. LPAs observed fire extinguishers, working smoke and carbon monoxide detectors. Continuation on next pages:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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: VILLAGE LITTLE	FACILITY NUMBER: 430701365
	VISIT DATE: 02/22/2023

NARRATIVE

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Amy stated that there are no firearms in the facility. Drinking water is readily available for the children outdoor via pitchers and cups and individual water bottles. The playground is surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by canopies, trees and building overhang. LPAs observed tanbarks as resilient material under and around the climbing structures and swings. LPAs observed synthetic grass as resilient material under and around the small climbing structures. There were no bodies of water observed.

LPAs reviewed 12 children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Parent Right's Receipt, Personal Rights, Physician's Report, Health History, Immunization, and TB test.

LPAs reviewed six (6) staff files. Staff records reviewed include Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza) and required training. LPAs reminded Site 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.

This facility provides Incidental Medical Services (IMS). LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

Site 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.

Continuation on next page:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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: VILLAGE LITTLE	FACILITY NUMBER: 430701365
	VISIT DATE: 02/22/2023

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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.

The following updated forms were received during the inspection:
1) Children's Roster
2) Personnel Report (LIC 500)
3) Administrative Organization (LIC 309)

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

Exit interview conducted and report was reviewed with Site Director, Amy Spillar.

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: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC809 (FAS) - (06/04)

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