430709874-7-30-2021-07-CC-MSMS-C5EUDB-20210730152917

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430709874
Report Date: 07/30/2021
Date Signed: 07/30/2021 03:29:23 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:	CALIFORNIA YOUNG WORLD # 5 - SCHOOL AGE		FACILITY NUMBER:	430709874
ADMINISTRATOR:	JENIFER TA		FACILITY TYPE:	840
ADDRESS:	1110 FAIRWOOD AVENUE		TELEPHONE:	(408) 245-7285
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94089
CAPACITY:	56	CENSUS: 15	DATE:	07/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Jenifer Ta		TIME COMPLETED:	01:15 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) Mel Matos met with Jenifer Ta, director, for an unannounced Required - 1 year inspection (KIT 2). LPA notes that the school age program is licensed in Rooms 7 & 8 on the campus of Fairwood Elementary School. The Facility also has an infant program (#430710229) in Rooms 1 & 2 and a preschool program (#430703885) in Rooms 3-6 on the same site. LPA toured the indoor and outdoor areas of the Facility with Jenifer during today's inspection. 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), Menus, and Activity Schedule. A review of staff records on July 29, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Jenifer 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 criminal record background checks are associated to the preschool license (#430703885). LPA reviewed ten children's and four staff files (1 director and 3 teachers) during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). All staff files reviewed contain the required transcripts/verification of experience/immunization records and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. There is at least one staff per Classroom with current CPR and First Aid certifications on file. Jenifer 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). LPA observed eight school age children with 1 teacher in Room 7 and seven school age children in Room 8 with 2 teachers during today's inspection. LPA notes that the Facility is Title 5 funded and thus Title 5 ratios apply. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 07/30/2021):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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: CALIFORNIA YOUNG WORLD # 5 - SCHOOL AGE	FACILITY NUMBER: 430709874
	VISIT DATE: 07/30/2021

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/30/2021):

Jenifer understands the conditions, limitations, and capacity specifications of the Facility license.
Jenifer understands that children shall be visually supervised at all times. The Facility is aware of the required sign in and sign out procedures for school age children who arrive at the Facility on their own. Jenifer states that all school age children are picked up by their respective parent(s)/guardian(s).

LPA observed that all rooms are clean and safe for all children, staff, and visitors. Jenifer states that the Facility has a third-party cleaning service that cleans 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 water bottles and water dispensers. The Facility has a dishwasher in Room 8 to clean & sanitize reusable plates, cups, and utensils. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Jenifer states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors in each room.

The food preparation and 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 and stored in high cabinets inaccessible to children. Any poisons are stored in the locked storage shed, located near Room 7. Any medications at the Facility are stored in each individual classroom.

LPA observed all furniture and equipment is in good condition and safe for the children. The school age children have a separate playground from the preschool & infant children. The playground area has 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 are sufficient resilient materials in the outdoor playground area. LPA did not observe any bodies of water.

Licensing Forms, Title 22 Regulations and information can be obtained through the internet at www.cdss.ca.gov. LPA conducted an exit interview with Jenifer prior to the conclusion of today's inspection and advised her that no deficiencies issued during today's inspection.

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

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC809 (FAS) - (06/04)

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