430710075-11-16-2022-07-CC-PHEZ-CL92DZ-20221116161909

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710075
Report Date: 10/27/2022
Date Signed: 11/16/2022 04:19:31 PM

Document Has Been Signed on 11/16/2022 04:19 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 - HIBISCUS (INFANTS)		FACILITY NUMBER:	430710075
ADMINISTRATOR:	MERCEDES MENDOZA		FACILITY TYPE:	830
ADDRESS:	801 HIBISCUS LANE		TELEPHONE:	(408) 985-5998
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95117
CAPACITY:	106	CENSUS: 37	DATE:	10/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Brandie Gonzales		TIME COMPLETED:	02:15 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 Analysts (LPA) Pietro Hernandez conducted an unannounced, Required 1 Year inspection, met with the Infant Program Director, Brandie Gonzales and explained the nature of today's inspection. LPA noted the following ratios in the various infant rooms during time of inspection: Room 1: 3 teachers /9 infants Room 2: 3 teachers /12 infants Room 4: 2 teachers / 8 infants Room 6: 1 teachers / 5 infants The facility was in compliance with teacher/infant ratios, children were not left unattended and were constantly under the direct visual supervision of a staff person. LPAs noted the staff and infants were interacting in various activities. Facility operates in the premises of West Valley Middle School, from Monday - Friday 7:00 AM to 6:00 PM. Facility has active waivers for: Electronic sign in system Shared use of rooms 13, 14, 15 with Preschool program. Outdoor Playground LPA completed a physical plant inspection touring the building inside and out. No bodies of water were found. Director stated that there are no weapons stored in the facility. Disinfectants, cleaning solutions, poisons, and other items that are dangerous to infants were inaccessible. Furniture and equipment was in good condition, free of sharp, loose, or pointed parts. Facility has age appropriate furniture and equipment, including cribs, mats, feeding chairs, and changing tables. Infant changing tables are located within arms reach of a sink. No baby walkers or bouncers were witnessed during the inspection. All storage containers for solid waste had tight fitting covers and were in good repair. Facility was free of flies, other insects, and rodents. Facility has adequate indoor activity space for infants that is physically separate from space used by the preschool child care center. Bottles, dishes, and containers of food brought by the infant's authorized representative are labeled with the infant's name and current date. Facility has at least one functioning carbon monoxide detector that meets statutory requirements. Facility has adequate outdoor activity space and play equipment that is maintained in a safe condition and is free of hazards. Facility maintains a kitchen for school children. Continued on Page #2. Report dated 10/27/2022

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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

FACILITY NAME: PRIMARY PLUS - HIBISCUS (INFANTS)	FACILITY NUMBER: 430710075
	VISIT DATE: 10/27/2022

NARRATIVE

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LPA reviewed safe sleep policies for the infants with the Director LPA also discussed the responsibility for providing care and supervision for infants while napping including the need for a staff member to be present when there is an infant napping. There were no infants napping at the time of inspection. LPA gave copy of Safe Sleep Information Flyer and a copy of the LIC 8227 as it relates to infants..

LPA reviewed 10 infant files and all the required documentation was in the file. LPA also reviewed 10 Teachers files and all required documentation was found in the file.

There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. Children's Roster was reviewed, and a copy obtained.

TYPE A language: 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 NOT 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, Brandie Gonzales, 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: (408) 314-5102
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC809 (FAS) - (06/04)

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