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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400174
Report Date: 07/30/2019
Date Signed: 07/30/2019 12:54:34 PM

COMPREHENSIVE INSPECTION
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:COLLINS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434400174
ADMINISTRATOR:SMITH, SHARONFACILITY TYPE:
840
ADDRESS:10300 BLANEY AVENUETELEPHONE:
(408) 446-5428
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:92CENSUS: 16DATE:
07/30/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:02 AM
MET WITH:Sharon SmithTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Marilou Monico and Pete Hernandez, met with Site Director, Sharon Smith, for an unannounced annual random inspection. The school age program is operating in Room 33 and two portable classrooms. LPAs observed all required posted materials: License, Parent’s Rights, Emergency Disaster Plan, menus, Earthquake Preparedness Checklist, Child Passenger Safety Law, and activity schedule. The school age program's days and hours of operation are Monday to Friday from 7:30 AM to 6:00 PM.

LPAs inspected the buildings both indoor and outdoor. LPAs observed that the facility was operating in compliance with teacher to children ratio requirement. Children were engaged in activities under the supervision of the teachers. LPAs observed that four children were not signed out for the month of July 2019. LPAs obtained a copy of current children's roster. Cleaning products were stored in locked cabinets inaccessible to children. Foods and beverages were kept protected against contamination and spoilage. LPAs observed trash can for the disposal of solid waste has tight fitting cover. There are functioning carbon monoxide detector and smoke detectors at the facility. LPAs did not observe any bodies of water. LPAs reviewed 5 random children's files and 2 staff files. Site Director has current CPR/First Aid certification with an expiration date of September 14, 2019. Per Site Director, there are no weapons on the premises.

The areas around high climbing structures have tanbarks as resilient materials to absorb falls. Drinking water was readily available to children indoor and outdoor via drinking fountains and individual water bottles. Activities schedule and Menus were posted. Facility provides breakfast, lunch and afternoon snacks for the children. There is a kitchen at the facility for food preparation. The kitchen is equipped with refrigerator, microwave, dishwasher, stove, oven, and sink with hot and cold running water. LPAs observed that food storage areas were clean, free of litter, and rodents.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 07/30/19):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2019
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: COLLINS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434400174
VISIT DATE: 07/30/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/30/19):

Staff present during the inspection have cleared criminal record and child abuse index clearances or exemptions. LPA also reminded Acting Site 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: 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 violation within a 12 month period.

LPA discussed Senate Bill 792, AB 633, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years with Site Director. Licensing forms, Title 22 regulations, can be obtained through the internet at ww.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com.

Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

As a result of this inspection, deficiency was cited on the following page:

A NOTICE OF SITE VISIT WAS ISSUE AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: COLLINS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434400174
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2019
Section Cited
CCR
101229.1(a)(1)
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SIGN IN AND SIGN OUT - The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. This requirement is not met as evidenced by: LPAs observed four children were not signed out for the month of July 2019. This poses a potential risk to the health and safety to children in care.
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Site Director submitted a written plan during the inspection to ensure that families are signing in and out their children with their full legal signature and record the time.

Deficiency corrected.
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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 StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2019
LIC809 (FAS) - (06/04)
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