434408763-10-1-2021-07-CC-AMOS-C7DL34-20211001082319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408763
Report Date: 09/30/2021
Date Signed: 10/01/2021 08:23:26 AM

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: 6	DATE:	09/30/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Rosie Flores		TIME COMPLETED:	04:05 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	(#1) LPA Licensing Program Analyst conducted an Annual Required Inspection. LPA was greeted by Director Rosie Flores. The Facility is located on the campus of Bowers Elementary School in Room 23. Operating hours are 7:00am-6:00pm The program is operated by the Santa Clara Unified School District and all criminal background checks for staff are handled by the Department of Education and thus do not come under the jurisdiction of Community Care Licensing Division. LPA observed six infants with Director, and two teachers. Facility was observed to be in compliance with teacher to child ratio requirement during 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), Menus, and Activity Schedule. The changing table is in arm's reach with a sink. There are cubbies for each of the infants personal belongings. There is a washer and dryer inside the bathroom. There is a refrigerator which is used to store the infants perishables and a plastic storage box with each of the children's names on them. The trash bins have tight fitted lids. All of the disinfectants and toxic materials are stored inaccessible to the children. (page 1)

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

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: 09/30/2021

NARRATIVE

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Observed a fully charged 2A; 10BC fire extinguisher. in the front area of the classroom. The Carbon monoxide is interconnected with the Emergency Fire Alarm. Last disaster drill was conducted on 6/25/21. LPA was informed that the parents use a electronic sign/sign out. LPA obtained a current Children''s Roster

LPA observed three cribs and mats. The cribs are separated by safety gate. The Isolation area will be inside the teacher's area inside the front of the classroom. Observed age appropriate furnishings.

LPA observed a secured fenced playground Shade is equipped by a canopy. Age appropriate play structure is equipped with resilient material. There is water available for the infants.

A sampling of children and staff files was taken for review during today's inspection. Children records reviewed include Identification and Emergency Contact, Parent Rights Notice, Medical Assessment, Immunization, and Infant Needs and Services Plan. LPA, also, reviewed Diaper changing documentation and Sleep Care plan.

Staff records reviewed include Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record, required Training and Mandated Reporter Training. LPA reminded Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPA reminded Licensee 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.
(page 2)

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

LIC809 (FAS) - (06/04)

Page: 4 of 4

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: 09/30/2021

NARRATIVE

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LPA also reviewed with Licensee the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

In the areas that were evaluated, there were no deficiencies cited.

LPA discussed the requirements of AB 633 with the Licensee. The Director understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations with the Director and advised the Director of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

LPA conducted an exit interview with the Licensee. LPA discussed and left a copy of Pin 20-24-CCP, RECENTLY APPROVED SAFE SLEEP REGULATIONS IN EFFECT. Discussed that all INFANTS UP TO 12 MONTHS OF AGE MUST HAVE AN INDIVIDUAL INFANT SLEEPING PLAN (LIC9227) OF FILE, WHICH WILL DOCUMENT THE INFANTS SLEEPING HABITS, USUAL SLEEPING ENVIRONMENT, AND THE INFANT ROLLING ABILITIES.

A copy of this report was provided to the facility at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED. LICENSEE WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: 09/30/2021

NARRATIVE
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SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4