434404385-5-29-2019-07-CC-TDON-BCMPPE-20190529112924

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404385
Report Date: 05/29/2019
Date Signed: 05/29/2019 11:29:31 AM

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:	SJB - NORTHWOOD CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	434404385
ADMINISTRATOR:	IRENE WONG		FACILITY TYPE:	850
ADDRESS:	2760 TRIMBLE ROAD		TELEPHONE:	(408) 538-0200
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95132
CAPACITY:	48	CENSUS: 41	DATE:	05/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Irene Wong		TIME COMPLETED:	11:35 AM

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) Tuoc Doan conducted an unannounced Annual inspection of the Preschool. LPA met with Site Director Irene Wong and informed her the purpose of the visit. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, and LIC613A Personal Rights were observed to be posted. Currently, the Preschool's operating hours are Monday through Friday 07:00 AM to 06:00 PM. Age serve is 2 years old until entry into first grade. The program is operating on a functioning school site, Northwood Elementary School, and is located in one of the portables labeled #600. Facility holds a waiver to share the outdoor activity space with another program under the condition that the Preschool children will not be commingled with children from other programs. Currently, the Preschool Program is sharing the outdoor activity space with the Family Resource Center (FRC) located in portable labeled #700. The Activities schedule was posted. LPA inspected the the building inside and out. LPA 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. Portable #600, the boys restroom (with two toilets), girls restroom (with two toilets), staff restroom, kitchen, storage room, and office room were inspected. There were no bodies of water observed. Site Director stated that facility do not have weapons on the premises. Furniture and equipment were age appropriate and were in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, poisons, and other items that are dangerous to children were stored inaccessible to children. Restrooms for children to use were observed to be in operating conditions. Floors were clean. Outdoor activity space is enclosed by fencing and is observed to be free of hazards. Play equipment was in good condition and areas around high climbing equipment have resilient material to absorb falls.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

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: SJB - NORTHWOOD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434404385
	VISIT DATE: 05/29/2019

NARRATIVE

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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 to a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day to a maximum of $3000.00 per person.

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. LPA provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

In the areas that were evaluated, no regulatory violations were observed at the time of the visit. Exit interview was conducted, where this report was reviewed with Site Director.

A NOTICE OF SITE VISIT WAS ISSUE AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

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: SJB - NORTHWOOD CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434404385
	VISIT DATE: 05/29/2019

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LPA observed that drinking water was readily available to children indoor and out. Menu was posted. Facility provides Breakfast, Lunch, and Snack. The meals and snack are packaged at the Main Office and deliver to the facility. Foods and beverages were kept protected against contamination and spoilage. Kitchen, and food storage and preparation areas were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on, and were in good repair.

This facility has an Incidental Medical Services – IMS Plan but per Site Director, there are no children at the Preschool who require the provision of IMS. 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.

First Aid Kit was inspected. At least one fire extinguisher, smoke detector, and carbon monoxide detector were observed. Fire Extinguisher was last serviced on 07/2018. Log shows that Fire and Earthquake drills were last conducted on 05/14/2019. LPA observed facility has a San Jose Fire Safety and Hazardous Materials Permit issued on 09/18/2018.

LPA reviewed sign in and out record. A sampling of children and staff files was taken for review during today's inspection. Children records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, and immunization.

Staff records reviewed include Criminal Record and Child Abuse Index Clearance, Health Screening Report with TB Clearance, Immunization (Measles and Pertussis) record and required Training. LPA reminded Site Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. Teachers and Site Director have the required qualifying education credits and experience. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPA also reviewed with Site Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Site Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019

LIC809 (FAS) - (06/04)

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