430706092-4-28-2022-07-CC-MMOO-CDWPXV-20220428114257

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430706092
Report Date: 04/28/2022
Date Signed: 04/28/2022 11:44:21 AM

Document Has Been Signed on 04/28/2022 11:44 AM - 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:	CHANDLER TRIPP HEAD START		FACILITY NUMBER:	430706092
ADMINISTRATOR:	TAFOYA, VICKI		FACILITY TYPE:	850
ADDRESS:	780 THORNTON WAY		TELEPHONE:	(408) 573-4894
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY:	40	CENSUS: 6	DATE:	04/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:58 AM
MET WITH:	Dee Vo & Vicki Tafoya		TIME COMPLETED:	11:55 AM

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) Marilou Monico met with Site Director, Dee Vo, and teacher, Vicki Tafoya, for an unannounced Required 1-year Inspection. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The center's operating days and hours are Monday through Friday 08:15 AM to 2:15 PM. The facility serves children ages 2.9 years to entry into kindergarten in Rooms 1 and 2. LPA toured the facility both indoor and outdoor. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Floors were clean. Foods and beverages were kept protected against contamination and spoilage. Drinking water is available for the children indoor via water dispenser and disposable cups. Trash can for solid waste had tight-fitting cover on, and was in good repair. Fire extinguisher, working smoke and carbon monoxide detectors were observed. Dee stated that there are no firearms in the facility. Drinking water is readily available for the children outdoor via water jug and disposable cups. The playground areas are surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by building overhang, tree, and canopy. LPA observed rubber foams as resilient material under and around the climbing structures. There were no bodies of water observed. 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: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

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: CHANDLER TRIPP HEAD START	FACILITY NUMBER: 430706092
	VISIT DATE: 04/28/2022

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LPA reviewed 12 children'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, Medical Assessment, and Immunization.

Four (4) staff files were reviewed. Staff records reviewed include Criminal Record Statement, Personnel Record, Employee Rights, Health Screening Report with TB Clearance, Immunization (Measles, Pertussis, and Flu) record and required Training. LPA reminded Site Director that the online Assembly Bill (AB)1207 Mandated Reporter Training needs to be renewed every two years. All staff present during the inspection have current certifications in Pediatric CPR and First Aid.

This facility provides Incidental Medical Services – IMS. LPA 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

Fingerprint clearances for individuals working at the facility are issued by the Santa Clara Department of Education and do not come under the jurisdiction of Community Care Licensing Division.

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 the Site Director, Dee Vo.

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: 04/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2022

LIC809 (FAS) - (06/04)

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