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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408756
Report Date: 10/03/2019
Date Signed: 10/03/2019 05:29:20 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:ACTION DAY PRIMARY PLUSFACILITY NUMBER:
434408756
ADMINISTRATOR:RITIPAL(NEEKA)JUNEJAFACILITY TYPE:
840
ADDRESS:5845 ALLEN AVENUETELEPHONE:
(408) 629-6020
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:46CENSUS: 21DATE:
10/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Ritipal (Neeka) JunejaTIME COMPLETED:
05:25 PM
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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 46. Licensing staff met with Director Ritipal (Neeka) Juneja. The program currently operates 6:30 AM 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 was a total census of 21 children and a total census of three teachers present. All areas identified on the Facility Sketch were inspected. This is a school aged program which consists of classrooms; 6 and 12.
PHYSICAL PLANT:
Room 6: The following was observed of this room during the inspection of the facility: Upon arrival, Room 6: had 3 staff with 21 school age; 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 cubicle to store their belongings. Per Director Juneja, 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 Juneja states that poisons are locked in the staff room closet. All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, and rubbish. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition. Director Juneja states waste is to be discarded immediately after each meal. First Aid supplies were observed in the classroom in a cabinet. According to Director Juneja, medication is only administered to a child when accompanied with a doctor's note and is stored in the office. Carbon monoxide detectors and smoke detectors are working presently in the facility. There is a Fire extinguisher size 3A40BC in this room and has been serviced on 11/12/2018. Teacher and child ratios were observed and staff names recorded. LPA Almaraz concludes, this room is currently in compliance with licensing standards. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 10/03/2019
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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: ACTION DAY PRIMARY PLUS
FACILITY NUMBER: 434408756
VISIT DATE: 10/03/2019
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Room 12:

The following was observed of this room during the inspection of the facility: Upon arrival there were no teachers or children present in this room. Director Juneja states children are on a field trip. 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 cubicle to store their belongings. Per director Juneja, 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 Juneja states that poisons are locked in the staff room closet. All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter and rubbish. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition. Director Juneja states waste is to be discarded immediately after each meal. First Aid supplies were observed in the classroom in a cabinet. According to Director Juneja, medication is only administered to a child when accompanied with a doctor's note and is stored in the office. Carbon monoxide detectors and smoke detectors are and working presently in the facility. There is a Fire extinguisher size 3A40BC in this room and has been serviced on 11/12/2018. LPA Almaraz concludes, this room is currently in compliance with licensing standards.

Lavatories:

The following was observed of the lavatories during the inspection of the facility: There are two lavatories labeled “boys” and “girls” located near the playground area. Director Juneja states the two lavatories are shared with the preschool children. Director Juneja states that at no point are the lavatories used at the same time. Director Juneja states supervision and schedule differentials acts as a deterrent from commingling. LPA Almaraz observed the following in the “boys” lavatory: 7 urinals, 3 toilets/stalls and 6 sinks. LPA Almaraz observed the following in the “girls” lavatory: 6 toilets/stalls and 4 sinks. LPA observed lavatories including the sinks/ toilets and urinals are accessible. All lavatories have appropriate water temperature, sufficient toilet paper, area safety and sanitation. LPA Almaraz observed soap dispenser and disposable towels in the school aged lavatories. LPA Almaraz concludes, both lavatories and all toilets/commodes and sink/washbasins are currently in compliance with licensing standards. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 10/03/2019

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

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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: ACTION DAY PRIMARY PLUS
FACILITY NUMBER: 434408756
VISIT DATE: 10/03/2019
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Outdoor area:
The following was observed of the outdoor playground during the inspection of the facility: There is one playground that school age kids use. The Director states the playground is shared with the preschool kids. Director Juneja states that at no point is the playground used at the same time. Director Juneja states supervision and schedule differentials acts as a deterrent from commingling. Director states the preschool children use the playground from 3:00 PM to 4:30 PM, the school age children use this area from 4:30PM to 5:15PM, daily. Outdoor playground equipment is in a 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. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. Outdoor equipment was inspected for safety, cushioning material, standard condition and appropriateness. Required shade, drinking water and fencing were inspected. LPA Almaraz advised that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. There were no bodies of water or hazards observed, Director Juneja states there are no weapons on the premises. LPA Almaraz concludes, the outdoor area is currently in compliance with licensing standards. There is currently transporting of the children in care.

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. Children's roster was reviewed and is current. Sign-in and out sheets and procedures were reviewed, there is currently a waiver on file allowing electric use of sign in/sign out. Children present were signed in. Personal Rights of children were observed by LPA Almaraz. Disaster/fire drill log was available, last drill was conducted on 09/18/2019. LPA Almaraz observed required postings including but not limited to; the facility sketch, emergency disaster plan (LIC 610), notification of parent's rights (PUB 393), and the emergency evacuation route map, and license. Snacks were reviewed for availability, quantity and appropriateness to children in care. School age children bring their own food. The facility provides AM and PM snack/s. LPA advised Director Juneja 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.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #4 - REPORT DATED 10/03/2019

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

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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: ACTION DAY PRIMARY PLUS
FACILITY NUMBER: 434408756
VISIT DATE: 10/03/2019
NARRATIVE
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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. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

LPA Almaraz informed Director Juneja 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.

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.

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. There is currently transporting of children within schools. Director Juneja understands the necessary supervision and requirements regarding transportation.

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

There was one type B deficiency during today's inspection in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1


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

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

REPORT CONTINUED FROM THE PREVIOUS PAGE (PAGE #4 - REPORT DATED 10/03/2019
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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: ACTION DAY PRIMARY PLUS
FACILITY NUMBER: 434408756
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/24/2019
Section Cited

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Admission agreements: Admission agreements shall specify the following: Right of the Department to perform the duties authorized in Sections 101200(b) and (c).This requirement was failed to be met as evidenced by licensing staff observed although child one through five had admission agreements there was not , licensing inspection authority.
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termination. This poses a potential risk to the health and safety of the children 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: 10/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2019
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: ACTION DAY PRIMARY PLUS
FACILITY NUMBER: 434408756
VISIT DATE: 10/03/2019
NARRATIVE
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A total of four Staff Records, including Directors file were reviewed. Criminal Record Clearances were reviewed for adults. 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.) All staff have sufficient evidence of qualifications in compliance with ratio requirements. All staff have completed Mandated Reporter Training and understand training is to be completed every two years following the initial completion.

A total of five Children’s Records were reviewed for completeness; Inspection of required forms was made. In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary LPA Almaraz observed missing information in admissions agreements, please refer to page 809D of this report.

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



The following was discussed with the Director:
Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. The fire extinguisher type 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.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #5 - REPORT DATED 10/03/2019
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
LIC809 (FAS) - (06/04)
Page: 6 of 6