430709349-10-28-2019-07-CC-SYIP-BHDUKB-20191028153853

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430709349
Report Date: 10/28/2019
Date Signed: 10/28/2019 03:39:01 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:	YMCA-PARADISE VALLEY		FACILITY NUMBER:	430709349
ADMINISTRATOR:	SARAH FARIA		FACILITY TYPE:	840
ADDRESS:	1400 LA CROSSE DRIVE		TELEPHONE:	(408) 466-2463
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	60	CENSUS: 27	DATE:	10/28/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Sophie Jaime and Maia Skeen		TIME COMPLETED:	03:45 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) Samantha Yip conducted an unannounced annual random inspection. LPA met with Site Supervisor Sophie Jamie and Program Director Maia Skreen and explained the reason for the inspection. Present during the inspection were 27 children and 3 staff. The staff child ratio was observed to be in compliance. Facility is located on the Paradise Elementary School campus in the portables. License, Emergency Disaster Plan, and Notification of Parent's Rights were observed to posted. LPA toured the inside and outside of the facility. Facility was observed to clean and sanitary. All disinfectants and cleaning supplies were observed to be stored inaccessible to children in care. There is sufficient amount of toys for children in care. Furniture and equipment, such as tables and chairs, were observed to be age appropriate and in good condition. Restroom for children's use was observed to clean and in functioning condition. LPA observed a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last fire/disaster drill was conducted 10/2019. Site Supervisor stated that there are no weapons, such as firearms, stored on the premise. Facility uses playground and field on elementary school campus. Area is fenced. Playground was observed to be in good condition. Area around playground has resilient material to absorb falls. LPA discussed with Program Director Maia about leveling out the resilient material. No bodies of waters were observed during today's inspection. ----------------------continues on 809 dated 10/28/2019 page 2------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2019

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: YMCA-PARADISE VALLEY	FACILITY NUMBER: 430709349
	VISIT DATE: 10/28/2019

NARRATIVE

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------------------------continuation of 809 dated 10/28/2019 page 2-----------------------------

Facility does provide snacks to children in care. Menu was observed to be posted. Drinking water is provided through Brita.

10 children's file were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and consent for emergency medical treatment.

2 staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit and Mandated Reporter Training. Site Director stated that S-1 started working on 10/18/2019 and is in the process of completing the Mandated Reporter Training. LPA reminded Program Director to have S-1's Mandated Reporter Training certification upon completion. LPA also reminded Program Director that Mandated Reporter Training requires renewal every 2 years. There is staff with current valid CPR/1st Aid, which expires on 08/2021.

All staff present have cleared criminal record clearance and child abuse index clearance. LPA also 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. Penalty amounts: minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

Program Director stated that there are no children in care who require Incidental Medical Services (IMS). 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.

As a result of today's inspection, no deficiencies have been cited. An exit interview was conducted, where this report was discussed and provided to Program Director Maia Skreen. A notice of site visit has been issued and must be posted for 30 consecutive days.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2019

LIC809 (FAS) - (06/04)

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