434400285-11-6-2019-07-CC-SRED-BHNT6M-20191106132724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400285
Report Date: 11/06/2019
Date Signed: 11/06/2019 01:27:32 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:	SAN JOSE DAY NURSERY INFANT/TODDLER PROGRAM		FACILITY NUMBER:	434400285
ADMINISTRATOR:	ELENA JOLLY		FACILITY TYPE:	830
ADDRESS:	33 N. 8TH STREET		TELEPHONE:	(408) 288-9667
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	24	CENSUS: 19	DATE:	11/06/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Elena Jolly		TIME COMPLETED:	01:35 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) Shannel Reed met with Executive Director, Elena Jolly, for an unannounced annual/random inspection today and informed her of the purpose of today’s inspection. LPA toured the Center both inside and outside during today’s visit. 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 (includes current and following weeks), and Activity Schedules. LPA observed 19 infants with 7 teaching staff (4 teacher and 3 aides). LPA reviewed six (6) children’s files. LPA observed the medical assessment, immunizations, Information and Emergency Information form (LIC 700) and additional documentation is complete. LPA reviewed the Individual feeding plans and the Needs and Services plans for the infants in care which are stored in the classroom. LPA observed that 3 out of the 6 plans reviewed have not been updated at least quarterly as required. A review of staff records 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 reviewed four (4) infant teachers staff files. All four Infant Teachers have a current CPR and First Aid Certifications on file. The Ms. Jolly 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). LPA observed that the teacher/child ratio was in compliance during today’s visit. Ms. Jolly understands the conditions, limitations, and capacity specifications of the Facility license. The Ms. Jolly understands that children shall be visually supervised at all times. LPA observed that the Immunizations against Measle, Pertussis and Influenza (or an opt-out statement) and the required Mandated Reporting Training (AB1207) are completed and on file for each teacher. *Facility Evaluation Report dated 11/06/19 to be continued on next page:*

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

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: SAN JOSE DAY NURSERY INFANT/TODDLER PROGRAM	FACILITY NUMBER: 434400285
	VISIT DATE: 11/06/2019

NARRATIVE

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Facility Evaluation Report dated 11/06/19 to be continued from previous page:
LPA observed that the classrooms are clean and safe for all children and staff. Drinking water is readily available for the children inside and outside via a personal bottles or sippy cups. LPA observed solid waste containers with tight-fitting lids in the classroom and in the playground area.

Ms. Jolly states that there are no weapons on the premises. Lunch and snacks are provided by the center. Lunch is prepared in the on-site kitchen. Parents also bring additional food from home, if preferred. Food is stored in the refrigerator in the classroom. The food preparation area is adequately equipped with ovens, refrigerators, and hot and cold running water. There is also adequate food for snacks and regular meals for the children. Cleaning supplies are stored inaccessible to the children. Any medications at the center are stored in a lock box in the front office. First Aid kit is stored in the classroom, out of reach of the children.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. LPA observed no bodies of water.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regard to new regulations. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list childcareadvocatesprogram@dss.ca.gov. LPA discussed and provided Lead Safety information (AB 2370).

LPA obtained a Facility roster and conducted an exit review with the Site Director.
Title 22 Deficiencies were observed and cited on the attached 809D page.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

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: SAN JOSE DAY NURSERY INFANT/TODDLER PROGRAM	FACILITY NUMBER: 434400285
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/06/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/06/2019 Section Cited	1 2 3 4 5 6 7	Infant Care Food Service: There shall be an individual feeding plan for each infant. (4) The plan shall be updated as often as the authorized representative wants, or as necessary to reflect changes in any of the areas specified above.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: LPA observed that at least three of the infants in care have not had the Individual Feeding Plan updated as necessary to reflect changes in the children’s feeding needs. This is a potential risk to the children in care.	8 9 10 11 12 13 14
Type B 12/06/2019 Section Cited	1 2 3 4 5 6 7	Modifications to Infant Needs and Services Plan: The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. (1) The director, the assistant director or a teacher shall update the plan with the assistance of the infant's authorized representative. (2) The authorized
	8 9 10 11 12 13 14	representative shall sign the plan to verify that he/she has participated in updating it. This requirement is not met as evidenced by: LPA observed that at least three of the infants in care have not had the Infant Needs and Services Plan updated at least quarterly, or as often as necessary to assure its accuracy. This is a potential risk to the children in care.	8 9 10 11 12 13 14

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: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2019

LIC809 (FAS) - (06/04)

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