430710231-9-20-2019-07-CC-SCRL-BG7N2C-20190920100431

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710231
Report Date: 09/20/2019
Date Signed: 09/20/2019 10:04:40 AM

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 - CAMPBELL		FACILITY NUMBER:	430710231
ADMINISTRATOR:	LAURIE HAUFF		FACILITY TYPE:	830
ADDRESS:	1125 W. CAMPBELL AVE		TELEPHONE:	(408) 379-3184
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY:	80	CENSUS: 49	DATE:	09/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:04 AM
MET WITH:	Laurie Hauff		TIME COMPLETED:	10:15 AM

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), Stephanie Rangel, conducted an unannounced random inspection to the Facility today. LPA met with director Laurie Hauff and explained the nature of today's inspection to her. LPA toured the Facility both inside and outside 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. 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. LPA reviewed 10 children's and 5 staff files during today's inspection. Each child's file reviewed contains emergency information. The staff files reviewed contain the required transcripts/verification of experience. Director has current CPR and First Aid certifications on file with an expiration date of September 2019. 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). Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. LPA observed that all rooms are clean and safe for all children and staff. LPA observed solid waste containers with tight-fitting lids throughout the Facility. The classroom is clean, sanitary, and operable. Director states that there are no weapons or firearms on the premises. 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. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

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: PRIMARY PLUS - CAMPBELL	FACILITY NUMBER: 430710231
	VISIT DATE: 09/20/2019

NARRATIVE

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Each infant has personal items individually stored and labeled. Infant Needs and Service Plan are up to date. Cleaning supplies are stored away from children. Medication(s) at the facility will be stored in the nurse's office. Each room has a working carbon monoxide and smoke detector.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by toddler children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. Drinking water is readily available for the toddler children in the outdoor playground area. Personal sippy cups and pitchers/disposable cups are available for the toddler children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient materials in the outdoor playground area. LPA did not observe any bodies of water.

Incidental Medical Services (IMS) plan is on file.

Facility has already been giving out the Effect of Lead Exposure handout dated 1/20/19 to enrolling and re-enrolling parents or guardians.

Deficiency cited on the following page. Appeal rights printed and reviewed with director.

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

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

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: PRIMARY PLUS - CAMPBELL	FACILITY NUMBER: 430710231
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/20/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/23/2019 Section Cited	1 2 3 4 5 6 7	Staff-Infant Ratio - There shall be a ratio of one teacher for every four infants in attendance. This requirement was not met as evidenced by LPA viewing, upon entering room 14 with Director, two staff with 9 infants. Within 30 seconds, a third staff member arrived in the room. This poses a potential risk Health, Safety Personal Rights risk to children in care.
	1 2 3 4 5 6 7
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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: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C Rangel	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019

LIC809 (FAS) - (06/04)

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