434400376-1-16-2020-07-CC-SRED-BKW2TP-20200116164105

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400376
Report Date: 01/16/2020
Date Signed: 01/16/2020 04:41:13 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:	MCA GRANADA ISLAMIC SCHOOL		FACILITY NUMBER:	434400376
ADMINISTRATOR:	LINA HAMOUDEH		FACILITY TYPE:	850
ADDRESS:	3003 SCOTT BOULEVARD		TELEPHONE:	(408) 980-1161
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95054
CAPACITY:	45	CENSUS: 12	DATE:	01/16/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:13 PM
MET WITH:	Lina Hamoudeh		TIME COMPLETED:	04:50 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 Site Supervisor, Lina Hamoudeh, for an unannounced annual/random inspection today and informed her of the purpose of today’s inspection. LPA toured the facility 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. The teacher/child ratio was in compliance during today’s visit. LPA observed 12 children with teaching staff (2 Teachers and 1 Aides). LPA reviewed five (5) children’s files. LPA observed the Immunization's, Information and Emergency Information form (LIC 700) and additional documentation is complete. 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) Teacher files. All Teachers have a current CPR and First Aid Certifications on file. The Site Supervisor 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). The Site Supervisor understands the conditions, limitations, and capacity specifications of the Facility license. The Site Supervisor understands that children shall be visually supervised at all times. LPA observed that the Immunization's against Measles, Pertussis and Influenza (or an opt-out statement) and the required Mandated Reporting Training (AB1207) are not on file at the time of LPA’s inspection. LPA observed that the classrooms are clean and safe for all children and staff. Drinking water is readily available for the children inside via personal water bottles and a water cooler. LPA observed solid waste containers with tight-fitting lids in the classroom and in the playground area. Facility Evaluation Report dated 01/16/20 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: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

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: MCA GRANADA ISLAMIC SCHOOL	FACILITY NUMBER: 434400376
	VISIT DATE: 01/16/2020

NARRATIVE

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Facility Evaluation Report dated 01/16/20 continued from previous page:
The Site Supervisor states that there are no weapons on the premises. Lunch and snacks are provided from home. If, necessary, the facility can obtain additional snacks and lunch for children from the on-site school cafeteria. LPA observed a garbage can with a tight fitting lid in each classroom. Cleaning supplies are stored inaccessible to the children. Any medications at the center are stored inaccessible to 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. Drinking water is available outside via personal water bottles and/ or water pitcher and disposable cups. 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 Site Supervisor 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. The Mandated Reporter Training (AB1207) can be completed at the website listed. http://www.mandatedreporterca.com. LPA discussed Assembly Bill (AB) 2370 and gave Lead Safety information.

LPA obtained a Facility roster and conducted an exit review with the Site Supervisor.

Title 22 Deficiencies were cited during today’s inspection.

NOTICE OF SITE VISIT WAS GIVEN AND MUST BE 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: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

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: MCA GRANADA ISLAMIC SCHOOL	FACILITY NUMBER: 434400376
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/16/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/28/2020 Section Cited	1 2 3 4 5 6 7	On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: LPA observed that four staff have not completed the required Mandated Reporter training. The Site Supervisor understand this is a potential risk to the children in care and a deficiency to the Health and Safety regulations.	8 9 10 11 12 13 14
Type B 02/14/2020 Section Cited	1 2 3 4 5 6 7	Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: LPA observed during file reviews that four staff members do not have proof of Immunity against Pertussis, Measles and Influenza (or opt out statement) on file. This poses a potential health and safety risk to 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: 01/16/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020

LIC809 (FAS) - (06/04)

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