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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406701
Report Date: 10/26/2022
Date Signed: 10/26/2022 05:34:08 PM


Document Has Been Signed on 10/26/2022 05:34 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:CAMPBELL CHRISTIAN EARLY CHILDHOOD CENTERFACILITY NUMBER:
434406701
ADMINISTRATOR:KATHY HARMONFACILITY TYPE:
830
ADDRESS:1075 WEST CAMPBELL AVENUETELEPHONE:
(408) 370-4900
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:38CENSUS: 22DATE:
10/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Knickerbocker, Erin TIME COMPLETED:
05:30 PM
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On this day Licensing Program Analyst/s (LPA/s) Almaraz, Celi conducted an unannounced annual random inspection. Due to COVID- 19 precautionary measures were taken. This facility is currently licensed for a capacity of 38. Licensing staff met with assistant (Director) Knickerbocker, Erin and explained the nature of today’s inspection. This is an infant program that currently operates from 7:00AM to 6:00PM, Monday thru Friday. Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. At the initial start of this visit, there was a total census of 22 infants and a total census of 8 staff, including one Director, 4 teachers, and 3 assistants were present. This is a double component facility, there is a preschool program 430706089 on campus. This is also on a school campus Campbell Christian Elementary schools (elementary & junior school).

Physical Plant: All areas identified on the Facility Sketch were inspected. This an infant program which consists of the following classrooms: The Infant Room. LPA observed the following: Staff # 1, # 2 both fully qualified teachers with 7 infants. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to one sink. The Early Toddler Room. LPA observed the following: Staff # 3, # 4 one fully qualified teacher and one assistant with 7 infants. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to one sink. The Toddler Room. LPA observed the following: Staff # 5 thru #7, one fully qualified teacher, two assistant with 8 infants. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to two sinks. The infant Room is in proximity to The Early Toddler and Toddler rooms, which are adjacent to one another.

LPA observed the following that all items that may pose a threat to children were locked in the cabinets area. LPA observed safety knobs on doors. All classrooms observed to have suitable furniture and equipment, which were inspected for age appropriateness. All classrooms observed to have sufficient have telephone services, heating, lighting, and ventilation. LPA has advised facility continuously clean the air conditioning units in classrooms 1/6
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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: CAMPBELL CHRISTIAN EARLY CHILDHOOD CENTER
FACILITY NUMBER: 434406701
VISIT DATE: 10/26/2022
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General sanitization & safety: Children have their own cubby to store their belongings or use individual back pack. Per Assistant Director, sick children are isolated in the director's office. LPA advised Director that all storage containers for solid waste, including moveable trash receptacles must have tight-fitting covers that are kept on, and in standard condition and for best practice foot petals to open. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Disinfectants, cleaning solutions, medication and other hazardous items that pose a risk to children, were inaccessible to the children in care. Director states that poisons are kept with the custodian. No bodies of water or other hazards were observed during inspection. Director understands that smoking is prohibited. Per Assistant Director there are no firearms on site.

Kitchenette: Each classroom has kitchenette area. Director states waste is to be discarded immediately after each meal. Director states any dishes or utensils are washed with soap and hot water daily.

Food: All food is brought from home. LPA observed food is labeled. Facility has Snacks (AM/PM), available upon request or as needed. LPA reviewed food for availability, quantity and appropriateness to children in care. Snacks and supplemental food with 5 components kept on site. Per Director there is an allergy list for each child posted in kitchenette areas. LPA and director discussed a name, picture and allergy list posted in kitchenette area for best practice. Director states there are currently no children enrolled with allergies.

Lavatories/change tables: Per Director there are no children in care that are potty trained. All change tables and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, the office is used as an isolation area for a sick child in care. Directors states that the staffroom lavatory is in the main office of the school.

Outdoor Playground: Equipment is in safe condition, free of sharp, defective or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. 2/6

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
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: CAMPBELL CHRISTIAN EARLY CHILDHOOD CENTER
FACILITY NUMBER: 434406701
VISIT DATE: 10/26/2022
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There is adequate shade in the play yard. Availability of outdoor drinking water was observed. There is a locked storage in the playground, where toys are kept. LPA and Director discussed for best practice filling in or obstructing two holes in the cushioned area.


Facility Records: LPA/s issued Review of Staff records (LIC 859) to the Director during this inspection. At least one staff (Director) has record of CPR and First Aid, valid until 07/07/2023. All staff present have the following: MMR & Tdap vaccinations, flu vaccine or the opt out. All staff has completed Mandated Reporter Training, Directors training valid thru 09/22/2023. Directors understand this must be renewed every two years. LPA/s reviewed 3 children's files and issued an LIC 857. LPA reviewed 8 staff files total. All files were observed to be complete.

Sign in and out: Procedures were reviewed by LPA/s to ensure that children who are present where sign in. Facility uses a paper sign in/sign out system. LPAs obtained a roster and personnel report at the conclusion of this inspection.

Waivers: There is one waiver on file for outdoor activity space, allowing the infant program to use preschool play yard at different times. LPA observed that facility is currently in compliant with the terms of the waiver in accordance with California code of regulations. Title 22, Division 12, Section 101238.2, Outdoor Activity Space.

Medical & First Aid Supplies: There is a first aid kit in each classroom, kept in a backpack. LPA reviewed kit to ensure supplies are complete. Director states that supplies are checked every month. Per Director medication is only administered to a child when accompanied with a doctor's note, parent plan, authorizations are to be completed monthly. The medication is kept in a locked cabinet and/or in emergency backpack when outside (at least six feet high) which is stored out of reach of children. LPA advised Director to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. For commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Postings: Parent’s Rights Poster (with complaint Hotline) was observed during this inspection. LPA observed all required postings, including license and emergency disaster plan. LPA and Director discussed updating relocation the event of an emergency, Director will fill out form and post on or by the end of this work week. 3/6

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: CAMPBELL CHRISTIAN EARLY CHILDHOOD CENTER
FACILITY NUMBER: 434406701
VISIT DATE: 10/26/2022
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Per Director there are currently no children enrolled who required Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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

Fire & Safety: Carbon monoxide detectors and smoke detectors are working and present in the facility, the fire department conducted a fire inspection on 10/19/2022. There is access to a Fire extinguisher, size 4A80BC outside of the three rooms. Last fire drill was conducted on 09/30/2022 Director understands this is to be completed at least every six months.

Matts and cots: Cots inspected for napping were observed to be maintained in a safe condition with no exposed foam. Constructed of material at least 3/4 inch thick. Covered with vinyl or similar material that can be wiped. Designed so that the sleeping side can be distinguished from the floor side. Per Director cots are wiped daily with a detergent, disinfectant or when soiled or wet. Each cot observed to be equipped with a sheet and/or blanket to cover the child. Per Director bedding is not shared and is washed on site each daily (or when soiled) to be laundered. LPA reminded Director that bedding shall be individually stored so that each child's bedding is identifiable, and no child's used bedding shall meet other bedding. Bedding is stored in a hamper to wash, per Director there is always a supply of clean linens.



Lead Testing: Director states a certified external water sampler was taken this month. Director stated one water fountain did not pass, has been capped. Director understands providers must submit the LIC 9275, a completed signed and dated childcare sampling checklist form LIC9276 and a facility sketch LIC 999 fully labeled with locations of all water outlets to their LPA and self report testing results. Director did not have the report on hand, will turn this in at the end of next week. 4/6
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: CAMPBELL CHRISTIAN EARLY CHILDHOOD CENTER
FACILITY NUMBER: 434406701
VISIT DATE: 10/26/2022
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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/inspection-process
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.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

The following was discussed:


· Reporting Requirements.
· The facility shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations.
· All personnel shall be in good health and shall be physically and mentally capable of performing assigned tasks; personnel that pose a threat to the health and safety of children shall be relieved of their duties.

All personnel shall be given on the job training in housekeeping, sanitation principles and universal health precautions.

LPA advised the facility representative to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. 5/6
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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: CAMPBELL CHRISTIAN EARLY CHILDHOOD CENTER
FACILITY NUMBER: 434406701
VISIT DATE: 10/26/2022
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Safe sleep: LPA/s observed and inspected sleeping equipment for infants. LPA/s observed cribs for each infant who is unable to climb out of the play yard. All equipment meets the US Consumer Product Safety Commission safety standards. Please see www.safekid.org for a list of any recalled products. LPA/s observed that cribs are free from loose articles and objects. There are no objects hanging above or attached to the side of the cribs. LPAs observed that play yards do not hinder the entrance or exit to and from the space they are sleeping in. Mattresses were observed to be firm and covered with a fitted sheet that is appropriate to the mattress size. Each infant has their individual bedding and is washed daily or as required. Bedding is replaced when wet or soiled and is placed in an area inaccessible to infants. Pacifiers were observed to not be attached to anything. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping. LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was reviewed. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. A review of PIN 20-24-CCP Recently approved Safe Sleep Regulations in Effect was discuss and a copy was provided to the Licensee during this inspection. LPA reminder Director that staff shall physically check on and document the following: 1. Breathing, Sleep position, signs of distress; specified in Responsibility for Proving care and supervision for infants 101429 of Title 22 for more information.

There are no deficiencies being cited in accordance to Title 22 of the California Code of Regulations and Health & Safety codes.

LPA and Director discussed the following: 1. Updating 610 relocation site. 2. Replacing trash bins with foot petals. 3. Filling in two crevices in play yard. 4. Organization of staff files. 5. Ensuring there are enough replacement nipples and bottles on site. 5. Submitting lead testing results the Department. Please see link on ccld website. 6. Making a name to face and allergies chart system. Director understands failure to do so may result in future citation/s and will email proof to LPA within four weeks. LPA may return to do a case management if needed.
A notice of site visit was issued and must remain posted for 30 consecutive days.

Exit interview conducted and report was reviewed with facility representative 6/6
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
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