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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710075
Report Date: 03/21/2024
Date Signed: 03/22/2024 08:06:37 AM


Document Has Been Signed on 03/22/2024 08:06 AM - It Cannot Be Edited

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:PRIMARY PLUS - HIBISCUS (INFANTS)FACILITY NUMBER:
430710075
ADMINISTRATOR:MERCEDES MENDOZAFACILITY TYPE:
830
ADDRESS:801 HIBISCUS LANETELEPHONE:
(408) 985-5998
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:106CENSUS: 28DATE:
03/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:08 PM
MET WITH:Renee TorresTIME COMPLETED:
01:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Other inspection. LPA met with Director Renee Torres and explained the reason for the inspection. Regional Director, Jamie Ferguson, arrived shortly after. The purpose of this inspection is to discuss director qualification.

The center submitted paperwork to change the director to S-1. Based on record reviews, S-1 does not met the qualification to be director per Section 101215.1 and 101415, which requires specific course work. S-1 does not have at least 15 semester units or equivalent and at least three (3) semester or equivalent quarter units in care of infant. S-1 is currently in the process of completed 13 quarter units.

LPA discussed with Director and Regional Director the regulation for director qualification. Regional Director stated that she will submitted the paperwork for a fully qualified director to Licensing by 03/29/2024.

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Director Renee Torres and Regional Director Jamie Ferguson. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024
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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Document Has Been Signed on 03/22/2024 08:06 AM - 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: PRIMARY PLUS - HIBISCUS (INFANTS)
FACILITY NUMBER: 430710075

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2024
Section Cited
CCR
101415(b)

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Infant Care Center Director Qualifications and Duties. At least three of the semester or equivalent quarter units required in Sections 101215.1(h)(1)(B), (h)(2) and (h)(3) shall be related to the care of infants.
This requirement is not met as evidenced by:
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By POC 03/29/2024, facility will submit paperwork for a fully qualified director who is also on site full time.
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Based on record review, center submitted paperwork for S-1 to be director, but S-1 has not completed at least 15 semester units. S-1 is the process of completed 5 quarter units in care of infants. This poses a potential health and safety risk to 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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024
LIC809 (FAS) - (06/04)
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