434408763-12-11-2019-07-CC-SRED-BJRTFY-20191211134219

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408763
Report Date: 12/11/2019
Date Signed: 12/11/2019 01:42:27 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:	BOWERS CHILD DEVELOPMENT INFANT PROGRAM		FACILITY NUMBER:	434408763
ADMINISTRATOR:	ROSALINDA FLORES		FACILITY TYPE:	830
ADDRESS:	2755 BARKLEY AVENUE		TELEPHONE:	(408) 423-1115
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	12	CENSUS: 9	DATE:	12/11/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Rosie Flores		TIME COMPLETED:	01:50 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) Shannel Reed met with the Director, Rosie Flores, for an unannounced annual/random inspection today and informed her of the purpose of today’s inspection. This facility is located at Bower Elementary School Campus in portable building F. LPA toured the facility both inside and outside during today’s visit. 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), and Activity Schedules. The teacher/child ratio was in compliance during today’s visit. LPA observed 9 infants with 5 teaching staff (4 teacher and 1 Aide) and the Program Director. The program has one waiver for commingling infants in the playground with preschooler between 8 to 9 AM. LPA observed that the classroom is clean and safe for children. Drinking water is readily available for the children in the room and in their playground via the child’s personal sippy cups and is refilled by the refrigerated filtered water pitcher. The changing table is within arm reach of a sink, and LPA observed the teaching staff cleaning the changing table and washing their hands and the children’s hands after each changing. All furniture observed to be in good condition and safe for the children. The nap area is separate from play area. LPA observed two children napping in the nap area. The program uses mats and cribs for children to nap. LPA reviewed the Safe Sleep Policy. LPA reviewed ten (10) children’s files. LPA observed the medical assessment, immunization's, Information and Emergency Information form (LIC 700) and additional documentation is complete. LPA reviewed the Individual feeding plans and the Needs and Services plans for the infants in care which are stored in the classroom. Needs & Services Plans also include individual feeding plans for each child and are updated once every six months or sooner if needed. Needs and services are kept in the room with the teacher. LPA discussed with the Director that per the regulation, the Needs and Services plans need to be updated at least quarterly. This facility is licensed through Santa Clara Unified school District and all staff are fingerprinted through School District. Facility Evaluation Report dated 12/11/19 to be continued on next page:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

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: BOWERS CHILD DEVELOPMENT INFANT PROGRAM	FACILITY NUMBER: 434408763
	VISIT DATE: 12/11/2019

NARRATIVE

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Facility Evaluation Report dated 12/11/19 continued from previous page:
LPA reviewed five (5) infant teacher staff files. All five Infant Teachers have a current CPR/ First Aid Certifications on file. The Director understands that there shall be at least one person, with valid CPR/ First Aid certifications, on site at all times or present during off-site activities (field trips). The Director understands the conditions, limitations, and capacity specifications of the Facility license. The Director understands that children shall be visually supervised at all times. LPA observed that the Immunization's against Measles, Pertussis and Influenza (or an opt-out statement) and the required Mandated Reporting Training (AB1207) are completed and on file for each teacher.
LPA observed that the classrooms are clean and safe for all children and staff. Drinking water is readily available for the children inside and outside via a personal bottles or sippy cups. LPA observed solid waste containers with tight-fitting lids in the classroom and in the playground area.
The Director states that there are no weapons on the premises. Lunch and snacks are provided by the parents. Food is stored in the refrigerator in the classroom, labeled and placed in labeled individualized bins. The food preparation area is adequately equipped with a microwave, bottle warmer, refrigerator, and hot and cold running water. There is also supplemental food for snacks or lunch provided by the parents and the center if needed. Cleaning supplies are stored inaccessible to the children. The Director states that there currently not any children that require and medications in care. Any medications at the center are stored in a lock box on top of the refrigerator. First Aid kit is stored in the classroom, out of reach of the children.
LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by the infants 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. LPA observed no bodies of water.
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the Director can obtain updated licensing information, new regulations and access forms. LPA advised the Director of their responsibility to stay current in regard to new regulations. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list childcareadvocatesprogram@dss.ca.gov. LPA discussed and provided Lead Safety information (AB 2370).
LPA obtained a Facility roster and conducted an exit review with the Director.

Title 22 Deficiencies were observed and cited on the attached 809-D page.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: BOWERS CHILD DEVELOPMENT INFANT PROGRAM	FACILITY NUMBER: 434408763
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/11/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/10/2020 Section Cited	1 2 3 4 5 6 7	The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. (1) The director, the assistant director or a teacher shall update the plan with the assistance of the infant's authorized representative. (2) The authorized representative shall sign the plan to verify
	8 9 10 11 12 13 14	that he/she has participated in updating it. This requirement is not met as evidenced by: LPA observed that some of the infants in care have not had the Infant Needs and Services Plan updated at least quarterly, or as often as necessary to assure its accuracy. This is a potential risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

LIC809 (FAS) - (06/04)

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