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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709411
Report Date: 01/10/2020
Date Signed: 01/10/2020 05:39:34 PM

COMPREHENSIVE INSPECTION
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:MANDALA CHILDREN'S HOUSEFACILITY NUMBER:
430709411
ADMINISTRATOR:PENNY LAWRIEFACILITY TYPE:
850
ADDRESS:5038 HYLAND AVENUETELEPHONE:
4082518633
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:60CENSUS: 48DATE:
01/10/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Julie SaccentoTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analysts (LPA) , Stephanie Collins, conducted an unannounced Annual inspection of the Preschool. LPA met with Director Julie Saccento 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 9:00 A M to 2:45 PM.

Facility was observed to be in compliance with teacher and adult to child ratio requirement during inspection. LPA inspected the building inside and out with Director. The Preschool classroom, restroom for children to use, Office area, Storage area, and food storage areas were inspected. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Restroom 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 snacks. LPA observed that food storage areas were clean, free of litter, rubbish, and rodents/vermin. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on.

Activity schedule was posted. Play area is enclosed by fence. LPA observed play equipment were maintained in a good condition, free of hazards. 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 is arranged to be readily available to children. Shade is provided by trees, etc. First Aid kit was inspected. Smoke and Carbon Monoxide detectors were tested and proved to be functioning and canopy.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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: MANDALA CHILDREN'S HOUSE
FACILITY NUMBER: 430709411
VISIT DATE: 01/10/2020
NARRATIVE
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Fully charged Fire Extinguishers were observed . Log recorded that the last fire/disaster drill was conducted on 10/05/2019. Facility has a Fire Safety & Hazardous Materials Permit, expires on 03/31/2020. LPA reviewed facility's sign in/out 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, and immunization. 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. LPA reminded Director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one person with documented current certification in Pediatric CPR/1st Aid present at the facility during LPA' 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.

This facility provides Incidental Medical Services – facility has established an IMS plan. 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.

LPA reviewed with Director the violations that would result in an immediate $500 civil penalty assessment. Director is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: ccld.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, Regulatory violations were observed at the time of the inspection. Exit interview was conducted, where this report was 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 KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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: MANDALA CHILDREN'S HOUSE
FACILITY NUMBER: 430709411
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2020
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years
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This requirement was not met as evidenced by:
LPAs observe wrong no certification was completed for the Mandated Reporter AB1207 Compliant Child Care Training in the Teachers 1-4. This poses a potential risk to the Health, Safety or Personal Rights of children in care.
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Type B
01/31/2020
Section Cited

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HEALTH & SAFETY CODE. Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. [...] The day care center shall maintain documentation of the required immunizations.
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This requirement is not met as evidenced by: Per LPA's review of files, Staff #2 and # 3 not have documented evidence of immunity against Measles, Pertussis dap, available for review during the inspection. This poses a potential risk to the health and safety of 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) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2020
LIC809 (FAS) - (06/04)
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