430709448-2-15-2023-07-CC-PHEZ-CP3SJ3-20230215125429

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430709448
Report Date: 02/15/2023
Date Signed: 02/15/2023 12:54:39 PM

Document Has Been Signed on 02/15/2023 12:54 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	PRIMARY PLUS - INFANTS		FACILITY NUMBER:	430709448
ADMINISTRATOR:	LOPEZ, LORENA		FACILITY TYPE:	830
ADDRESS:	18720 BUCKNALL ROAD		TELEPHONE:	(408) 370-0350
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	83	CENSUS: 45	DATE:	02/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Lorena Lopez		TIME COMPLETED:	01:29 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), Pete Hernandez, met with Center Director, Lorena Lopez, for an unannounced Required 1 Year inspection in the Infant Program. The Facility is currently using the Infant rooms 1, 2, 3 and rooms K5 and K6. The facility has two waivers on file for electronic sign in/ out and shared outside playground space. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Activity Schedule. Facility hours are Monday 7:00am through Friday 6:00pm. LPA and Director toured the indoor and outdoor areas of the Infant program during today's inspection. LPA observed that all rooms are clean and safe for all children and staff. Director states that the facility has company janitors that clean the facility Monday through Friday in the evenings. Drinking water is readily available for the children in each room and in the outdoor playground area via personal sippy cups or bottles. LPA observed solid waste containers with tight-fitting lids in each room. Director states that there are no weapons or firearms on the premises. The facility uses an optional hot food prepared at the Primary Plus Campbell location. Some food is brought from home. If a parent forgets a child’s food, the facility does not provide backup food or formula if the parent is unable to bring. The food is prepared in the classroom. Storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children. Any medications at the Facility are stored in the front office and are inaccessible to children in care. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 02/15/2023):

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PRIMARY PLUS - INFANTS	FACILITY NUMBER: 430709448
	VISIT DATE: 02/15/2023

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 02/15/2023):
LPA reviewed staff files during today's inspection. A review of staff records on 2/15/2023 indicates that all individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. 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. Penalty amounts: $100.00 per person per day, 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 violations within a 12-month period.

All teacher files were reviewed contain the required transcripts/verification of experience. At least one staff member on site has a current CPR and First Aid certification on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). All staff have the required Immunization's against Pertussis, Measles an Influenza (or an Opt out statement). LPA also observed the required Mandated Reporter Training on file for all staff. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. And that a teacher or aide is required to be present in the nap room any time a child is placed in the room. LPA observed:

Room 1: 2 Teachers and 5 Infants.
Room 2: 2 Teachers and 8 Infants.
Room 3: 1 Teachers and 4 Infants.
Room K-5: 4 Teachers and 16 infants.
Room K-6: 3 Teachers and 12 Infants.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground areas utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient material on the outdoor playground areas.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 02/15/2023):

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PRIMARY PLUS - INFANTS	FACILITY NUMBER: 430709448
	VISIT DATE: 02/15/2023

NARRATIVE

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Shade is provided by one large canopy, and two large umbrella’s. LPA did not observe any bodies of water. There are working smoke, carbon monoxide detectors and fire pull stations. Fire drills are conducted every month and are logged. Last entry was dated: 1/24/2023.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list. childcareadvocatesprogram@dss.ca.gov. LPA obtained an updated facility roster.
LPA Hernandez reviewed the files of 6 Teachers and 10 infant children. All of the required documentation was available except for infants, C1-C4, who had outdated needs and services plans.
This facility provides Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. 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.

SHOULD THERE EVER BE AN ISSUANCE of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

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. An exit interview was conducted with the Licensee. A copy of this report and appeals rights were discussed and left with the Licensee, Lorena Lopez, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/15/2023 12:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PRIMARY PLUS - INFANTS	FACILITY NUMBER: 430709448
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101419.3(a)(1)

Modifications to Infant Needs and Services Plan

(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. (1) The director, the assistant director or a teacher shall update the plan with the assistance of the infant's authorized representative. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's record review, the licensee did not comply with the section cited above since infants identifies as C1 through C4 did not have current needs and services plans on file; In which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/15/2023
	Plan of Correction
1 2 3 4	Licensee shall provide copies of updated needs and services plans for the infants identified and provide a written plan of correction to keep needs and services plans current as required. These will be provided to the CCLD by the POC date 3/15/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023

LIC809 (FAS) - (06/04)

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