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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400463
Report Date: 06/06/2019
Date Signed: 06/06/2019 03:24:41 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:EATON SCHOOL AGE CDCFACILITY NUMBER:
434400463
ADMINISTRATOR:AGUSTINEZ, MONICAFACILITY TYPE:
840
ADDRESS:20220 SUISUN DRIVETELEPHONE:
(408) 257-3570
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:70CENSUS: 31DATE:
06/06/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Monica AgustinezTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA), Marilou Monico, made an annual random inspection. LPA notes that the facility is licensed in Rooms 20 and 21. LPA toured the facility inside and outside. LPA observed all required posted materials: License, Parent’s Rights, Emergency Disaster Plan, menus, Earthquake Preparedness Checklist, Child Passenger Safety Law, and activity schedule. The center is located on C.B. Eaton Elementary School. Sign in/sign out sheets and children's roster were reviewed. Copy of children's roster was obtained. At least one staff member present during the inspection has current CPR/First Aid certifications.

The center is clean and in good repair. Disinfectants, cleaning solutions, and all other items that are dangerous to children were observed to be securely stored and inaccessible to children. Furniture and equipment were age-appropriate and in good condition. Restrooms for children’s use were observed to be sanitary and operable. Trash cans used for the disposal of solid waste have tight fitting lids. Site Director states that there are no weapons on the premise. LPA observed functioning carbon monoxide detector. LPA did not observe any bodies of water. LPA reviewed six random children's files and four staff files. Drinking water indoor is via drinking fountains, pitchers and cups. The center provides snacks to children in care. There is a kitchen in Room 21. The kitchen was observed to be clean and sanitary. The kitchen is equipped with microwave, stove, oven, refrigerator, dishwasher, and a sink with hot and cold running water.

The center uses the elementary school's playground after school hours. LPA observed climbing structures on the playground with tanbarks as resilient material. Drinking water outdoor is provided via drinking fountains.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06/06/19):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: EATON SCHOOL AGE CDC
FACILITY NUMBER: 434400463
VISIT DATE: 06/06/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 06/06/19):

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.

Staff present during the inspection have cleared criminal record and child abuse index clearance or exemption. LPA also 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. 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, 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. AB 633 was discussed 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. LPA discussed with Site Director regarding lead safety information and advised her to provide copies to parents.

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

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: 06/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2