434404979-5-29-2019-07-CC-SYIP-BCMUPC-20190529154520

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404979
Report Date: 05/29/2019
Date Signed: 05/29/2019 03:45:26 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:	LOS ARROYOS CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	434404979
ADMINISTRATOR:	OKSANA OKS		FACILITY TYPE:	840
ADDRESS:	885 MORO DRIVE		TELEPHONE:	(408) 843-9005
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	42	CENSUS: 26	DATE:	05/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:48 PM
MET WITH:	Oksana Oks		TIME COMPLETED:	03:50 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) Samantha Yip conducted an unannounced annual random inspection. Upon arrival of inspection. LPA met with Master Teacher Maria De Los Angeles and Receptionist Edith Cruz-Narez and explained the reason for the inspection. Director Oksana Oks arrived shortly after. Facility currently only uses Room 4 for the school-age children. Facility does bring the children to the park adjacent to the center. Present at the beginning of the inspection were at least 3 staff and 26 school-age children. Facility has a waiver share indoor activity space and outdoor activity space with preschool facility. LPA observed schedule is posted. LPA toured the inside and outside of the facility. The facility was observed to clean and sanitary. LPA inspected the restroom for children's use. Disinfectants, cleaning solutions, and all other items that are dangerous to children were observed to be securely stored and inaccessible to children. LPA observed there is sufficient amount of toys for children in care. LPA observed a fully charged fire extinguisher, carbon monoxide, and smoke detector. Director stated that there are no weapons stored on the premise. The facility does provide snacks to the children in care. Menu was posted. Kitchen used to prepare snacks was observed to be clean and sanitary. Drinking water is provided through drinking fountains. The outdoor activity area is fenced. The playground equipment outside were maintained in safe condition, free of sharp, loose or pointed parts. Shaded rest areas are provided through building overhang and pergola. LPA did not observe any bodies of water.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
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: LOS ARROYOS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434404979
	VISIT DATE: 05/29/2019

NARRATIVE

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11 children’s files were reviewed during today’s inspection. The records reviewed include but not limited to Parent’s Right Notice and admission agreement.

There is currently at least one staff on site with valid CPR/First Aid, which expires 12/08/2020. 3 staff files were also reviewed. The records reviewed include but not limited to education credits and Mandated Reporter Training.

Staff present during the inspection have cleared criminal record and child abuse index clearance or exemption. LPA also reminded 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: $100.00 per person per day, 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.

Director stated that she currently does not have any children in care who requires Incidental Medical Services (IMS) services. IMS policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.

Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

In areas evaluated during today's inspection, no deficiencies were cited as a result of today's inspection. An exit interview was conducted, where this report was discussed and provided with Director.

A NOTICE OF SITE VISIT WAS ISSUE AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
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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