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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434407592
Report Date: 01/29/2020
Date Signed: 01/29/2020 03:40:32 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:ALMADEN COUNTRY DAY SCHOOLFACILITY NUMBER:
434407592
ADMINISTRATOR:ELIZABETH LASHERFACILITY TYPE:
850
ADDRESS:6835 TRINIDAD DRIVETELEPHONE:
(408) 997-0424
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:36CENSUS: 17DATE:
01/29/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:08 PM
MET WITH:Lasher, ElizabethTIME COMPLETED:
04:01 PM
NARRATIVE
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An unannounced Annual Random Inspection was conducted on this day, by Licensing Program Analyst (LPA) Almaraz, Araceli. Facility is currently licensed for a capacity of 36. Licensing staff met with Director, Lasher, Elizabeth. The program currently operates 8AM to 6PM, 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 is a total census of 17 children and a total census of 5 teachers/staff present.
PHYSICAL PLANT
This is a preschool program which consists of classrooms; Pre K and JK class rooms . All areas identified on the Facility Sketch were inspected. Upon arrival the following was observed by LPA of the rooms: Pre K: Had 10 children in care with two teachers. Teacher child ratios were observed and staff names recorded. JK: Had 7 children in care with two teachers. Teacher child ratios were observed and staff names recorded. This class is used for transitional Kindergarten.This class room has a fish tank, with a lid.

Classrooms have two sinks, one facet and one commode each. Furniture and equipment were inspected for age appropriateness and are in sufficient condition. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Per director, the isolation area is in the office. 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 Lasher states that poisons are locked . *****Page 1/5*****

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 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: ALMADEN COUNTRY DAY SCHOOL
FACILITY NUMBER: 434407592
VISIT DATE: 01/29/2020
NARRATIVE
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According to Director Lashen, medication is only administered to a child when accompanied with a doctor's note and is stored in a locked medical box, in kitchen area. Carbon monoxide detectors and smoke detectors are working present in the facility. There is a Fire extinguisher size 3A40BC in each room, including kitchen and have been serviced on 09/02/2019 First Aid supplies were observed in the classroom in a cabinet. Matts/cots inspected and are in sufficient conditions.
All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition. Director states waste is to be discarded immediately after each meal. Menus are posted two weeks in advance where it is visible by the child's authorized representative. Menus for the past one year are available upon request. Snacks were reviewed for availability, quantity and appropriateness to children in care. Facility provides hot lunch from vendor or children can bring their own lunch. This facility provides AM and PM snacks. Although this area is shared with kindergarten, supervision and different schedules ensures there is no commingling. There is waiver on file for this. LPA observed that this facility is in compliance with the terms of the waiver.

Age appropriate sinks and toilets were inspected for availability and sufficient condition in all lavatories. LPA observed age appropriate sinks and toilets and were inspected for availability, water temperature, toilet paper, area safety and sanitation. LPA Almaraz observed the children's sinks are in working condition and meet licensing standards. LPA Almaraz observed soap dispenser and disposable towels in the preschool bathrooms. Staff has one separate bathroom that can be utilized by sick children if necessary. Sick children are isolated in the "sick room" of the maim office. There is a waiver on file for lavatory usage of Room 31, only in the event of an emergency. Supervision ensures the terms of this waiver are not violated. LPA observed facility is in compliance with the terms of this waiver. *****Page 2/5*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 2 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: ALMADEN COUNTRY DAY SCHOOL
FACILITY NUMBER: 434407592
VISIT DATE: 01/29/2020
NARRATIVE
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Outdoor playground equipment is in a safe condition, free of sharp, defective or pointed parts. The surface of the outdoor activity space is not maintained in a safe condition and has hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. Director states that this play area is used from 10:00 AM until 5:15 PM, Monday through Friday. This facility is licensed for 3.8 years to kindergarten.

Facility Records: Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. Personal Rights of children were observed by LPA. Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. Inspection of required forms made. LPA observed Admissions Agreement does not have Licensing Inspection Authority included. All individuals present have obtained a criminal record clearance or criminal record exemption. There is at least one person trained in CPR and Pediatric First Aid present during this inspection. (All staff have received an active criminal record clearance as a condition of their employment.) Children's roster is current. Disaster drill log was available, last drill conducted on 11/13/2019. Children present signed in

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/childqanda.htm *****Page 3/5*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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: ALMADEN COUNTRY DAY SCHOOL
FACILITY NUMBER: 434407592
VISIT DATE: 01/29/2020
NARRATIVE
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The following was discussed with the Director Lasher: Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. No infant walkers, no Johnny Jumpers, no excersaucers or any other item that falls into that category are allowed in facility. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. LPA also provided a complete packet of the Provider Information Network (PIN) 10-02-CCP dated February 20, 2019 regarding Safe Sleep Awareness Campaign during today’s inspection.

The fire extinguisher type 2A10BC or larger must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location. Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.
LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check.

LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility. Director advised that indoor and outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors. *****Page 4/5*****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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: ALMADEN COUNTRY DAY SCHOOL
FACILITY NUMBER: 434407592
VISIT DATE: 01/29/2020
NARRATIVE
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The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised to visit www.shotsforschool.org for immunization information.

These forms may also be downloaded from our website: www.ccld.ca.gov

There were two Type B deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

NOTICE OF SITE VISIT ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

Exit interview conducted, a copy of report was given. Appeal rights were issued and discussed.

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SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 5 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: ALMADEN COUNTRY DAY SCHOOL
FACILITY NUMBER: 434407592
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/29/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/06/2020
Section Cited

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Outdoor Activity Space: The surface of the outdoor activity space shall be maintained:(2)Free of hazards including, but not limited to, holes....This requirement was failed to be met as evidenced by licensing staff observed holes and cracks in the pavement in the playgroud area. This poses a potential risk to the health and safety of the chidlren in care.
Type B
03/06/2020
Section Cited

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Inspection Authority of the Department: The Department has the authority to interview children or staff without prior consent. This requirement was failed to be met as evidenced by licensing staff observed this information was not indicated on the admission agreement. This poses a potential risk to the health and safety of the chidlren in care.

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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:
DATE: 01/29/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/29/2020
LIC809 (FAS) - (06/04)
Page: 6 of 6