430710145-2-16-2023-07-CC-PHEZ-CP4T5C-20230216132515

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710145
Report Date: 02/16/2023
Date Signed: 02/16/2023 01:25:23 PM

Document Has Been Signed on 02/16/2023 01:25 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		FACILITY NUMBER:	430710145
ADMINISTRATOR:	GUZMAN, SHUREE		FACILITY TYPE:	840
ADDRESS:	18720 BUCKNALL RD		TELEPHONE:	(408) 370-0357
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	56	CENSUS: 0	DATE:	02/16/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Shuree Guzman		TIME COMPLETED:	01:50 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	On 02/16/2023 Licensing Program Analyst (LPA) Pete Hernandez conducted an unannounced Required 1 Year inspection of Primary Plus - Bucknall School Age today. LPA met with Director, Shuree Guzman and explained the purpose of today's visit. Facility’s License, Parents’ Rights Poster PUB393, Personal Rights, and Activity Schedules, were posted. Facility's operating days and hours are Monday to Friday 2:00PM AM to 6:00 PM. The Facility has two Waivers and are posted: Waiver for shared playground space and electronic sign in and sign out. LPA was unable to observe the capacity and ratio of the school age program because the school age program does not start until 2:30pm. Facility uses Rooms 10, and 6A. The physical plant was inspected. LPA toured the building with the Director. Indoor space: The classrooms, restrooms and office area were inspected. Director was present during inspection. Children are offered various activities under the visual supervision of the Teachers. LPA did not observe disinfectants, cleaning solutions or chemicals that are dangerous to the health and safety of children and were inaccessible to the children in care. All other cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazards. Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and rodents/vermin.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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	FACILITY NUMBER: 430710145
	VISIT DATE: 02/16/2023

NARRATIVE

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Trash cans for solid waste had tight-fitting covers on and were in good repair. Director stated that facility does not possess nor store any weapons on the premises. LPA observed 2A10BC Fire extinguishers, working combination Smoke and Carbon Monoxide Detectors, and fire pull stations. Log shows that the last Fire Drill was conducted on 1/24/2023. Facility does provide transportation for children, but Director understands that children cannot be left alone, unattended in parked vehicles.

Outdoor Space: Outdoor playground was inspected and observed to be safe. The play equipment was maintained in good condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls: redwood bark. There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities.

File Review: Children sign in and out procedures and logs were reviewed. A sampling of 10 Children's files and 4 Staff files were taken for review. All children's and staff files were complete with all required documentation. Staff files contained appropriate educational units. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. Director has current CPR and First Aid certificate that expires on 7/31/23, and at least one other Teacher has a current CPR and 1st Aid card. Children's Roster was reviewed and a copy was provided to the LPA.

Director stated that facility does handle medications and currently does not have children in care who require Incidental Medical Services. Facility has an approved IMS Plan on file with San Jose Regional Office. LPA reviewed storage of medication and equipment / supplies. Isolation of sick child was discussed, and Director explained that a sick child is brought to the office area to be isolated from other children. A child's restroom is used and is off limits to other children is located near the office is used if necessary. Child is always under visual supervision while in care of the facility.

Incidental Medical Services (IMS) policy was discussed. Licensee stated that she currently does have children in care who requires IMS. 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) & link to Commonly Asked Questions and the ADA, available at:<http://www.ada.gov/childqanda.htm> .

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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	FACILITY NUMBER: 430710145
	VISIT DATE: 02/16/2023

NARRATIVE

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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 per day with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person. LPA also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

The facility has a professional cleaning service that comes in 5 nights a week.

Website for provider resources:
http://www.cdss.ca.gov/inforesources/Community-Care/Self-Assessment-Guides-and-Key-Indicator-Tools/Quarterly-Updates
childcareadvocatesprogram@dss.ca.gov

SHOULD there ever be 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 were discussed and left with the Licensee, Shuree Guzman, 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: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC809 (FAS) - (06/04)

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