430710561-9-9-2021-07-CC-MSMS-C6PQFF-20210909120753

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710561
Report Date: 09/09/2021
Date Signed: 09/09/2021 12:07:59 PM

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:	CALIFORNIA YOUNG WORLD AT ELLIS		FACILITY NUMBER:	430710561
ADMINISTRATOR:	JOSEPHINE FELIX		FACILITY TYPE:	840
ADDRESS:	550 EAST OLIVE STREET		TELEPHONE:	(408) 774-0405
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	56	CENSUS: 0	DATE:	09/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Nora Lacayo		TIME COMPLETED:	12:15 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 Analyst (LPA), Mel Matos, met with Nora Lacayo, director, for an unannounced Required - 1 year inspection (KIT 2). LPA notes that the Facility is located on the campus of Ellis Elementary School in Portables A & B. LPA toured the Facility both inside and outside during today's inspection. Hours of operation: 6:30 AM to 8:30 AM and 12:45 PM to 5:45 PM Monday to Friday during the calendar school year. The school age program is open from 6:30 AM to 5:45 PM during school breaks. LPA notes that the Facility also has a preschool program (#434415223) which uses the same space; however, the preschool is only in operation from 8:30 AM to 11:30 AM Monday to Friday during the calendar school year. Both the preschool and school age program have exclusive use of Portables A & B when either program is in session. 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. A review of staff records on September 7, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Nora 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. All criminal record background checks are associated to the preschool license (#430703885). LPA reviewed ten children's and five staff (1 director and 4 teachers) files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). All staff files reviewed contain the required transcripts/verification of experience/immunization records, and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. There is at least one staff in the Facility with current CPR and First Aid certifications on file. Nora 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).

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

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: CALIFORNIA YOUNG WORLD AT ELLIS	FACILITY NUMBER: 430710561
	VISIT DATE: 09/09/2021

NARRATIVE

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No school age children were present during today's inspection. LPA notes that the Facility is Title 5 funded and thus Title 5 ratios apply. Nora understands the conditions, limitations, and capacity specifications of the Facility license. Nora understands that children shall be visually supervised at all times. The Facility is aware of the required sign in and sign out procedures for school age children who arrive on their own. Nora states that all school age children are picked up by their parent(s)/guardian(s) and no children are allowed to leave the Facility on their own.

LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Nora states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Nora understands that the Facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children. Drinking water is readily available for the children in each room and in the outdoor playground area via water bottles and water dispensers.

The Facility has dishwashers to clean & sanitize reusable plates, cups, and utensils. LPA observed solid waste containers with tight-fitting lids in each Portable. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Nora states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors in each room.

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 at 45 degrees F or less. Cleaning supplies are inaccessible to the children and stored in high cabinets inside each classroom. Nora states that the Facility does not administer any medication at this time.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. Shade is provided by trees and building overhangs in the playground area. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient materials (rubber padding) in the outdoor playground area. LPA did not observe any bodies of water.

LPA conducted an exit interview with Nora prior to the conclusion of today's inspection and advised her that no deficiencies issued during today's inspection.

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

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021

LIC809 (FAS) - (06/04)

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