434404979-10-10-2022-07-CC-SYIP-CK3LDX-20221010084040

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404979
Report Date: 10/07/2022
Date Signed: 10/10/2022 08:40:42 AM

Document Has Been Signed on 10/10/2022 08:40 AM - 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:	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:	28	CENSUS: 16	DATE:	10/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Maria Sernas and Oksana Oks		TIME COMPLETED:	03:20 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 Required- 1 Year inspection. LPA met with Maria Sernas, Master Teacher, and explained the reason for the inspection. Upon arrival, there were two staff and no school-age children present. Facility is located in Room 5 and the School-Age Yard. LPA met with Director Oksana Oks at 2:50PM. 2 additional staffs. There is an area to post required postings, such as license and notification of parent's rights. There is working phone on the premise. LPA reviewed electronic sign in/sign out. LPA toured the inside and outside of the facility. Facility was observed to be clean. Disinfectant, cleaning supplies, and other items that are dangerous to children were observed to be inaccessible to children. There are toys for children. All equipment were age-appropriate. Bathroom for children allow for individual privacy and is separated by genders. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last disaster drill was conducted on 08/2022. Director stated that there are no weapons, such as firearms, stored on the premise. The outdoor activity space is fenced. Master Teacher Maria stated that they will bring bikes and a additional toys for school-age children. The preschool program on site has a waiver to share the yard. There were no bodies of water observed during today's inspection. Shaded rest area is provided through building overhang and canopy. Facility provides meals and snacks for children. There is a kitchen to prepare and store meals and snacks. Menu was observed to be posted. Drinking water is provided through pitchers and cups. Trash can for waste have tight-fitted lids. ---------------------continues on 809 dated 10/07/2022 page 2---------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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: LOS ARROYOS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434404979
	VISIT DATE: 10/07/2022

NARRATIVE

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Facility currently does not provide Incidental Medical Services (IMS). For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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

Five (5) children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and consent for emergency medical treatment. LPA discussed with Site Director about ensuring facility name is correct on forms. LPA observed that C-1 had a different facility name on the forms.

Two (2) staff files were reviewed during today's inspection. The records reviewed include but not limited to Mandated Reporter training, health screening, and education credits. Both staff have a valid CPR/1st Aid. S-1's CPR/1st Aid expires on 08/12/2024 and S-2's CPR/1st Aid expires on 03/06/2023. Staff who transport children have a valid driver's license and CPR/1st Aid.

All staff present have cleared fingerprints. Director 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.

No deficiencies were cited as a result of this inspection. Exit interview conducted and report was reviewed with Director Oksana Oks. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC809 (FAS) - (06/04)

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