434404916-5-18-2022-07-CC-MMOO-CEJRZP-20220518132817

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404916
Report Date: 05/18/2022
Date Signed: 05/18/2022 01:28:38 PM

Document Has Been Signed on 05/18/2022 01:28 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	TLC OF CUPERTINO		FACILITY NUMBER:	434404916
ADMINISTRATOR:	THERESA CAMPBELL		FACILITY TYPE:	850
ADDRESS:	10038 BRET AVENUE		TELEPHONE:	(408) 996-1866
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	48	CENSUS: 15	DATE:	05/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Elaine Rositas		TIME COMPLETED:	01:50 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) Marilou Monico met with Site Director, Elaine Rositas, for an unannounced Required - 1 Year inspection. LPA toured the indoor and outdoor areas of the Facility during today's inspection. 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, and Activity Schedule. Days and hours of operation are Monday through Friday 8:00 AM to 5:30 PM. The facility is licensed to serve children ages 2 to 6 years old. LPA reviewed 12 children's and two staff files during today's inspection. Each child's file reviewed contains the required forms. LPA observed that none of the staff present during the inspection has current Pediatric CPR/First Aid certifications. Per record review, Staff #1 and #2 are missing current Mandated Reporter Training for Child Care Workers. Elaine 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). LPA reminded Elaine that the online Assembly Bill (AB)1207 Mandated Reporter Training needs to be renewed every two years (www.mandatedreporterca.com). LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA observed 15 children with two staff present (site director and 1 teacher's aide) in one of the classrooms. Elaine understands the conditions, limitations, and capacity specifications of the Facility license. Elaine understands that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the director’s office area. LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Elaine states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Elaine understands that the Facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children. Drinking water is readily available for the children in each Room and in the outdoor playground area via water individual water bottles. Staff ( 1 toilet and 1 sink) and children's bathrooms (4 toilets and 4 sinks) are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Elaine states that there are no weapons or firearms on the premises. The Facility has functioning smoke carbon monoxide detectors in each Room. Continuation on next page:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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: TLC OF CUPERTINO	FACILITY NUMBER: 434404916
	VISIT DATE: 05/18/2022

NARRATIVE

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The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees Fahrenheit or less. The Facility only provides morning and afternoon snacks to the children. Parents provide lunches for the children. The Facility has trash can with tight fitting lid for the disposal of solid waste. Cleaning supplies are inaccessible to the children and stored in high cabinets/shelves. LPA observed a complete First Aid kit in the Facility.

This facility provides Incidental Medical Services – IMS. Site Director states that none of the children enrolled is using medication. 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

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade is provided by trees. There is sufficient resilient materials (wood chips/sand) in the outdoor playground area. LPA did not observe any bodies of water.

Elaine was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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.

LPA provided Elaine the list of missing documents in her file as the new director of the center.

Exit interview conducted and report was reviewed with the Site Director, Elaine Rositas.

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

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/18/2022 01:28 PM - It Cannot Be Edited

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: TLC OF CUPERTINO	FACILITY NUMBER: 434404916
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the facility does not maintain documentation of fire/disaster drill. This poses a potential risk to the health, safety or personal rights of children in care.
	POC Due Date: 05/27/2022
	Plan of Correction
1 2 3 4	Site Director states that she will practice fire drill with the children and will submit documentation to Licensing by 05/27/22.

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 reviews, Staff #1 & #2 are missing current Mandated Reporter Training for Child Care Providers. This poses a potential risk to the health, safety or personal rights of children in care.
	POC Due Date: 07/01/2022
	Plan of Correction
1 2 3 4	Site Director states she will submit current Mandated Reporter Training certificate for Staff #1 and #2 by 07/01/22.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/18/2022 01:28 PM - It Cannot Be Edited

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: TLC OF CUPERTINO	FACILITY NUMBER: 434404916
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record reviews, none of the staff present during the inspection has current Pediatric CPR/First Aid certifications. This poses a potential risk to the health, safety or personal rights of children in care.
	POC Due Date: 07/01/2022
	Plan of Correction
1 2 3 4	Site Director states that she will submit proof of current CPR/First Aid certifications of at least one staff member working at the facility by 07/01/22.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC809 (FAS) - (06/04)

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