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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710231
Report Date: 04/03/2024
Date Signed: 04/03/2024 11:30:22 AM

Document Has Been Signed on 04/03/2024 11:30 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 - CAMPBELLFACILITY NUMBER:
430710231
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		LAURIE HAUFFFACILITY TYPE:
830
ADDRESS:1125 W. CAMPBELL AVETELEPHONE:
(408) 379-3184
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 80TOTAL ENROLLED CHILDREN: 100CENSUS: 74DATE:
04/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Alyssa ContrerasTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
11:40 AM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with the Site Director, Alyssa Contreras, and explained the purpose of the visit. Upon arrival, LPA was admitted into the facility by office staff.

The facility has indicated that the infant director is Macie Villegas, however, has not indicated who the assistant infant director is. Per Section 101415.1 an assistant director shall be present and on duty if there are more than 25 infants in attendance. The facility is licensed for a capacity of 80 infants and frequently has more than 25 infants in attendance. LPA additionally reminded that when a director is absent for more than 30 consecutive calendar days, the substitute director shall meet the qualifications of a director. The name of the director or change in the child care center designee shall additionally be reported to the Department within 10 days of the change.

During observation of classroom 22, LPA Nelson and LPA Mandeep Kaur observed that staff members were not completing infant nap logs on 3/12/2024 and 1/9/2024. Nap logs were observed in the classroom for infants, however, were not actively completed every 15 minutes for infants that were sleeping. LPAs observed staff member completed the log once the infant awoke from their nap, however no physical checks were made while LPAs were present in the classroom. The cribs are located behind a wall in the classroom, making visibility of the infants while napping limited without moving closer to the cribs themselves. Additionally, mobiles were observed to be hanging over the cribs in classroom 22 and LPA advised that no objects shall be hanging above cribs per Section 101439.1.

Joel Segura
Cortney Nelson
DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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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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: 04/03/2024
NARRATIVE
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Additionally, during observation on 1/9/2024, LPA Nelson observed that the temperature in classroom 20 was too cold as the room was 62 degrees inside and the classroom felt physically cold upon entering it. LPA advised that per Section 101239 the temperature of classrooms occupied by children shall remain between 68-85 degrees.

As a result of today’s inspection, deficiencies were cited, see LIC809-D.

Exit interview conducted and the report was reviewed with the Site Director, Alyssa Contreras.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 04/03/2024 11:30 AM - It Cannot Be Edited


Created By: Cortney Nelson On 04/03/2024 at 10:36 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 04/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/12/2024
Section Cited

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101439.1 Infant Care Center Sleeping Equipment (f) Cribs shall be free from all loose articles and objects... (3) There shall be no objects hanging above or attached to the side of the crib.

This requirement was not met as evidenced by:
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The Site Director did not ensure that there were no objects hanging above the cribs as four (4) mobiles were observed to be hanging over the infants cribs in classroom 22, which poses a potential risk to the health, safety, and personal rights of infants in care.
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Type B
04/12/2024
Section Cited

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101415.1 Assistant Infant Care Center Director Qualifications and Duties (a) In addition to the director, an assistant director shall be present and on duty if the center has 25 or more infants in attendance.

This requirement was not met as evidenced by:
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The facility has not appointed an assistant director and during visits conducted on 1/9/2024 and 3/12/2024, there were more than 25 infants in attendance, which poses a potential risk to the health, safety, and personal rights of infants in care.
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Assistant director packet to be submitted to the Department by 4/12/2024 and the person appointed should be aware of their position.
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 Segura
TELEPHONE:
LICENSING EVALUATOR NAME:Cortney Nelson
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 04/03/2024 11:30 AM - It Cannot Be Edited


Created By: Cortney Nelson On 04/03/2024 at 10:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 04/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/12/2024
Section Cited

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101429 Responsibility for Providing Care and Supervision for Infants (a) ..the following shall apply: (2) Sleeping infant(s) shall be directly observed by sight and sound at all times (B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following:

This requirement was not met as evidened by:
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The staff in classroom 22 were not physically checking on sleeping infants every 15 minutes as nap check logs were not completed and LPAs did not observe any staff members observing sleeping infants, which poses a potential risk to the health, safety, and personal rights of infants in care.
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Training review to be submitted and signed by staff members in classroom 22 by 4/12/2024.
Type B
04/12/2024
Section Cited

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101239 Fixtures, Furniture, Equipment, and Supplies (a) A comfortable temperature for children shall be maintained... (1) The Licensee shall maintain the temperature in rooms that children occupy between a minimum of 68 degrees F... and a maximum of 85 degrees F...

This requirement was not met as evidenced by:
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The facility did not maintain proper temperature for children in care as classroom 20 was observed to be 62 degrees when LPA Nelson observed the classroom, which poses a potential risk for the health, safety, and personal rights of children in care.
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Photos of labels for infant classroom thermostats to be submitted by 4/12/2024.
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 Segura
TELEPHONE:
LICENSING EVALUATOR NAME:Cortney Nelson
TELEPHONE:
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024


LIC809 (FAS) - (06/04)
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