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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400029
Report Date: 04/14/2022
Date Signed: 04/14/2022 04:34:58 PM

Document Has Been Signed on 04/14/2022 04:34 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CHRISTOPHER RANCH HEAD STARTFACILITY NUMBER:
434400029
ADMINISTRATOR:ROCIO ARNETTFACILITY TYPE:
850
ADDRESS:305 BLOOMFIELD AVENUETELEPHONE:
(408) 847-3110
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 13DATE:
04/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Angelica Guzman and Eva SuarezTIME COMPLETED:
01:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required 1- Year inspection. LPA met with Angelica Guzman, Teacher, and explained the reason for the inspection. Site Director Renee Garcia is currently off today. Site Supervisor Eva Suarez arrived shortly after. Present during today's inspection were 13 children, 3 staff, and 1 student teacher. Facility was observed to be within ratio during today's inspection.

There is a board to post required postings, such as license, emergency disaster plan, and notification of parent's right. There is a working phone at the facility. The hours of operation are Monday through Friday 5:45AM to 5PM. Facility uses an electronic sign in/sign out. LPA reviewed sign in/out during today's inspection.

LPA toured in the inside and outside of the facility. Room 2 is currently not being used for children and is currently being used as a staff room. Upon arrival, LPA observed that the temperature on the thermostat was 63 degrees Fahrenheit. LPA discussed with Site Director Eva about the regulation for temperature needs to be at least 68 degrees Fahrenheit. Site Supervisor turned the thermostat to 68 degrees Fahrenheit during today's inspection. Disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible to children. There is sufficient amount of toys for children. All equipment were observed to be age appropriate. There is fully charged fire extinguisher, smoke detector, and carbon monoxide. The last fire drill was conducted on 03/23/2022. Site Director stated that there are no weapons, such as firearm, stored in the facility.
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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: CHRISTOPHER RANCH HEAD START
FACILITY NUMBER: 434400029
VISIT DATE: 04/14/2022
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The outdoor space is fenced. The area around the play structure has resilient material. There were no bodies of water observed during inspection. Shaded rest area is provided through building overhang and trees.

All meals and snacks are provided. Food is prepared through a third party. There is a kitchen to store and prepare food. LPA did not observe the menu to be posted. Site Director printed out a copy of the menu and posted it during today's inspection. LPA reminded Director that menu needs to be posted. Drinking water is provided though water cooler or water jugs and cups.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

10 children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and physician's report. C-1 enrolled on 03/14/2022 and is still pending physician's report. Site Director understands that physician report needs to be obtained within 30 days of enrollment. Site Director stated that she will send C-1's physician's report to Licensing upon obtaining a copy.

3 staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit, immunization records, and CPR/1st Aid. There is at least one staff with a valid CPR/1st Aid, which expires on 03/06/2022. LPA also reviewed the student teacher's file, which has her immunization records and TB test.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
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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: CHRISTOPHER RANCH HEAD START
FACILITY NUMBER: 434400029
VISIT DATE: 04/14/2022
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All criminal records are done and monitored through Santa Clara County Office of Education. Site Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Facility will submit the following:

1) C-1's physician's report

2) Director Packet for Renee Garcia by 04/29/2022

As a result of this inspection, a Type B citation and two technical violations were issued. Exit interview conducted and report was reviewed with Site Supervisor Eva Suarez. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
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Document Has Been Signed on 04/14/2022 04:34 PM - It Cannot Be Edited


Created By: Samantha Yip On 04/14/2022 at 01:19 PM
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: CHRISTOPHER RANCH HEAD START
FACILITY NUMBER: 434400029

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(a)(1)
A comfortable temperature for children shall be maintained at all times. (1) The licensee shall maintain the temperature in rooms that children occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. The temperature on the thermastat was 63 degrees Fahrenheit, which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/14/2022
Plan of Correction
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Deficiency was correct during today's inspection. Site Director set thermastat to 68 degrees during today inspection.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 04/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/14/2022


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