434400287-9-20-2021-07-CC-MMOO-C72UWL-20210920155656

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400287
Report Date: 09/20/2021
Date Signed: 09/20/2021 03:57:01 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:	GOOD SAMARITAN ED. & ENRICHMENT PROGRAMS		FACILITY NUMBER:	434400287
ADMINISTRATOR:	CORIA, GUADALUPE		FACILITY TYPE:	830
ADDRESS:	19624 HOMESTEAD ROAD		TELEPHONE:	(408) 996-8290
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	24	CENSUS: 11	DATE:	09/20/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Guadalupe Coria & Stacey O'Toole		TIME COMPLETED:	03:15 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	#2 Licensing Program Analyst (LPA) Marilou Monico conducted an unannounced Required - 1 Year inspection. LPA met with Site Director, Guadalupe Coria, and Assistant Director, Stacey O'Toole, and explained the purpose of today's inspection. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The center is open Monday through Friday from 07:00 AM to 6:00 PM. Age serve is 6 weeks to 2 years old. The infant program is licensed in Rooms 10, 14, and 15. LPA toured the indoor and outdoor areas. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. There were no bodies of water observed. Per Site Director, there were no weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Outdoor activity space is enclosed by fencing and is observed to be free of hazards. LPA observed play equipment were in good condition and areas around the climbing structures have resilient material. Drinking water was readily available to children indoor and outdoor via water bottles. Activities schedule and Menus were posted. Facility provides morning and afternoon snacks for children in Room 15 and are prepared at the facility. LPA observed that food storage areas were clean. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste and disposal of diapers had tight-fitting covers on, and were in good repair. LPA observed working smoke detector and functioning carbon monoxide detector. Continuation on next page:

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

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: GOOD SAMARITAN ED. & ENRICHMENT PROGRAMS	FACILITY NUMBER: 434400287
	VISIT DATE: 09/20/2021

NARRATIVE

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LPA observed documentation that sleeping infants were checked every 15 minutes. Parents completed the Individual Infant Sleeping Plan (LIC 9227) for infants 0-12 months. Diapers are being disposed appropriately. Each infant has personal items individually stored and labeled. The Infant Needs and Services Plan are updated quarterly.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

LPA reviewed sign in and out. Six children's files and four staff files were reviewed. LPA reminded Site Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPA reminded 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

As a result of this inspection, there were no deficiencies cited.

A copy of this report was provided to the facility at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED. SITE DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

LIC809 (FAS) - (06/04)

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