434408003-11-12-2019-07-CC-MSMS-BHUVTN-20191112154325

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408003
Report Date: 11/12/2019
Date Signed: 11/12/2019 03:43:30 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:	SMALL WORLD ACADEMY		FACILITY NUMBER:	434408003
ADMINISTRATOR:	KEITH HADEN		FACILITY TYPE:	850
ADDRESS:	878 LAKEWOOD DRIVE		TELEPHONE:	(408) 737-7022
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94089
CAPACITY:	24	CENSUS: 8	DATE:	11/12/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Keith Haden		TIME COMPLETED:	04:00 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) Mel Matos met with Keith Haden, owner/director, for an unannounced annual/random inspection. LPA toured the Facility both inside and outside during today's inspection. LPA notes that the Facility is licensed in the following rooms: Orange, Blue, Red, & Yellow. 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), Snack Menu, and Activity Schedule. The Facility has no active waivers on file. A review of staff records on October 31, 2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Keith 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 violations within a 12 month period. LPA reviewed ten children's during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). No staff files were reviewed during today's visit since Keith has not had any turnover of staff since LPA's last visit on June 21, 2018. Keith has current CPR and First Aid certifications on file (expire: 08/10/2021). Keith 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). Keith has record of the required immunizations required for staff and proof of completion of the Mandated Reporter Training for Child Care Workers. LPA observed that the teacher/child ratio was in compliance during today's inspection. Keith understands the conditions, limitations, and capacity specifications of the Facility license. Keith understands that children shall be visually supervised at all times. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 11/12/2019):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2019

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: SMALL WORLD ACADEMY	FACILITY NUMBER: 434408003
	VISIT DATE: 11/12/2019

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 11/12/2019):

LPA observed that all rooms are clean and safe for all children and staff. Keith states that he cleans the Facility Monday through Friday in the evenings. Drinking water is readily available for the children within the Facility and in the outdoor playground area via drinking fountains. LPA observed solid waste containers with tight-fitting lids within the Facility. There are barricaded wall heaters in each room. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Keith states that there are no weapons or firearms on the premises.

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 F or less. The Facility provides snacks for the children and parents are responsible for providing lunches for the children. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Keith states that the Facility does not administer any medications at this time.

LPA observed all furniture and equipment is in good condition and safe for the children. 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. There is sufficient resilient materials in the outdoor playground area. LPA did not observe any bodies of water.

Licensing Forms, Title 22 Regulations, and information can be obtained through the internet at www.cdss.ca.gov

No deficiencies issued during today's inspection.

LPA conducted an exit interview with the Licensee prior to the conclusion of today's inspection and Keith agreed to submit a copy of the certificate of completion of the "mandated reporter" training for CA Child Care Workers and copies of the immunization records (pertussis (Tdap), measles (Mmr), and flu vaccines) for himself by Friday November 22, 2019.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2019

LIC809 (FAS) - (06/04)

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