434404883-3-3-2025-07-CC-MMOO-DEERRC-20250303121456

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404883
Report Date: 03/03/2025
Date Signed: 03/03/2025 12:17:21 PM

Document Has Been Signed on 03/03/2025 12:17 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	HEARTS & MINDS ACTIVITY CENTER		FACILITY NUMBER:	434404883
ADMINISTRATOR/ DIRECTOR:	ROSA BARNEOND		FACILITY TYPE:	850
ADDRESS:	2380 ENBORG LANE		TELEPHONE:	(408) 279-7515
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 22	CENSUS: 16	DATE:	03/03/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:40 AM
MET WITH:	Rosa Barneond		TIME VISIT/ INSPECTION COMPLETED:	12:25 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) Marilou Monico met with Site Director, Rosa Barneond, for an unannounced Annual Random inspection. The purpose of today's inspection was explained with Rosa. LPA observed all the required postings. The center's operating hours are Monday through Friday from 7:30 AM to 5:30 PM. The facility is licensed to serve children ages 2 years to entry into first grade. LPA toured the indoor and outdoor areas. LPA observed that the teacher-child ratio was in compliance. Fire drill was conducted on February 13, 2025. The facility has current children's roster. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The facility is clean. The bathrooms for children and staff are clean, sanitary, and operable. The center provides breakfast, lunch, and snacks to children. There is a kitchen at the facility for food preparation. The kitchen is equipped with stove, oven, refrigerator, microwave, dishwasher, and a sink with hot and cold running water. Drinking water is available for the children via pitchers and disposable cups. LPA observed trash cans with tight fitting covers for the disposable of solid wastes. The facility has the required size fire extinguisher and working smoke and carbon monoxide detectors. Rosa stated that there are no weapons or firearms on the premises. LPA reviewed 10 random children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment, Parent Right's Receipt, Physician's Report with tuberculosis test, Child's Preadmission Health History, Immunization Record, and Personal Rights. *Continuation on next pages:*

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HEARTS & MINDS ACTIVITY CENTER	FACILITY NUMBER: 434404883
	VISIT DATE: 03/03/2025

NARRATIVE

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LPA reviewed five (5) staff files. Staff records reviewed include Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza), educational requirements, and Mandated Reporter Training. Staff #1, #2, #4 and #5 have expired Mandated Reporter Training for Child Care Providers. LPA reminded Rosa that the Mandated Reporter Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

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/resources/child-care-centers/.

Site Director, Rosa Barneond, was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for
lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-
CCP).

Based on record review, licensee failed to test their water used for drinking and food preparation for lead contamination prior to January 1, 2023. LPA advised Site Director to complete the lead testing in accordance to the Written Directives outlined in PIN 21-21.1-CCP.
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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HEARTS & MINDS ACTIVITY CENTER	FACILITY NUMBER: 434404883
	VISIT DATE: 03/03/2025

NARRATIVE

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Site Director, Rosa Barneond, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&R's) throughout California.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

As a result of this inspection, Type B deficiencies were cited on the following page.

LPA received the following updated documents during the inspection:
1) Emergency Disaster Plan (LIC 610)
2) Administrative Organization (LIC 309)
3) Designation of Facility Responsibility (LIC 308)
4) Personnel Report (LIC 500)
5) Children's Roster

Exit interview conducted and report was reviewed with Site Director, Rosa Barneond.

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

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/03/2025 12:17 PM - It Cannot Be Edited

Created By: Marilou Monico On 03/03/2025 at 11:36 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: HEARTS & MINDS ACTIVITY CENTER	FACILITY NUMBER: 434404883
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/03/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee failed to test their water used for drinking and food preparation for lead contamination prior to January 1, 2023 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/10/2025
	Plan of Correction
1 2 3 4	Site Director states that she will make an appointment with a certified external water sampler to have their water used for drinking and food preparation tested for lead. Site Director states that she will submit a written plan of correction by 03/10/25.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day 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 following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, Staff #1, #2, #4 & #5 have expired Mandated Reporter Training for Child Care Providers which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/17/2025
	Plan of Correction
1 2 3 4	Site Director states that she will submit current certificates for the four staff by 03/17/25.

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:

Gladys Kuizon

LICENSING EVALUATOR NAME:

Marilou Monico

LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025

LIC809 (FAS) - (06/04)

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