434410824-5-8-2019-07-CC-SRED-BBYPVM-20190508113922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410824
Report Date: 05/08/2019
Date Signed: 05/08/2019 11:39:30 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:	OAK GROVE FROST		FACILITY NUMBER:	434410824
ADMINISTRATOR:	IZAMARY CORTEZ		FACILITY TYPE:	850
ADDRESS:	530 GETTYSBURG DRIVE		TELEPHONE:	(408) 225-1881
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	50	CENSUS: 29	DATE:	05/08/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Chan Chan Tran		TIME COMPLETED:	11:45 AM

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 Analysts (LPA), Shannel Reed arrived at the facility to conduct an unannounced annual/random inspection. LPA met with, Center Director, Chan Chan Tran, and informed her of the purpose of today’s inspection. The facility operates as a part day preschool program from 9AM to 12PM, in a portable located on site of Oak Grove Elementary School. LPA toured the Facility both inside and outside. LPA observed all the required posted materials. LPA observed that the teacher/child ratio was in compliance. The rooms are clean and safe for daycare children. The Director states that the school districts janitorial personnel clean the classrooms nightly after daycare hours. Children's bathrooms are sanitary and operable. However, the boy’s bathroom is in need of repairs to the paint and the base lining on the wall behind the toilet. The paint is missing in two large areas and the base lining is peeling away from the wall. Staff bathroom is located next to the children’s bathrooms on site. The center provides AM snack from the on site kitchen. The kitchen, food preparation and storage areas are clean, free of litter, rubbish and free of rodents and other vermin. The refrigerator has a temperature of 45 degrees or less. Drinking water is readily available for the children indoors via a water pitcher and disposable cups. The Director states that there are no weapons or firearms on the premises. The playground utilized by the Preschool program is at the opposite end of the Oak Grove Elementary School campus where the Kindergarten playground is located. The area is surrounded with appropriate fencing. Drinking water outdoors is available via disposable cups and a water pitcher. LPA observed that the resilient material under the climbing structure is sufficient. And the outdoor activity space is free of hazards. The program currently does not have any children enrolled that require medication. However, the 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. REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 05/08/19):

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

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: OAK GROVE FROST	FACILITY NUMBER: 434410824
	VISIT DATE: 05/08/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 05/08/19):
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

LPA reviewed six (6) children's files. Each file has the required Identification and Emergency Information form (LIC700), immunization's, and additional required documentation.

LPA reviewed three (3) staff files. A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. All Staff received background check clearances through the school district. The Director and the Lead Teacher, Neena Rani, have also been cleared through CCL. The Director is unable to provide LPA with current proof of CPR/First Aid certification for herself or her Lead Teacher, who is alone with children, at the time of the inspection. Staff have completed their Mandated Reporter Training and have their Immunization's against Measles, Pertussis and Influenza (or decline statement) on file.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the Facility staff can obtain updated licensing information, new regulations and access forms. 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. The Mandated Reporter Training (AB1207) can be completed at the website listed, http://www.mandatedreporterca.com.

Exit review was conducted with Center Director, Chan Chan Tran. Title 22 deficiencies cited during today’s inspection.

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: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

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: OAK GROVE FROST	FACILITY NUMBER: 434410824
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/07/2019 Section Cited CCR 101238(a)	1 2 3 4 5 6 7	Buildings and Grounds: The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.This requirement is not met as evidenced by: LPA observed paint is missing in two large areas and the base lining is peeling away from the wall in the boy’s	1 2 3 4 5 6 7	The Director shall ensure that the boys bathroom is repaired and send photos of completion to LPA by the POC due date of 06/07/19.
	8 9 10 11 12 13 14	restroom. The Director understands this is a potential risk to the children in care.	8 9 10 11 12 13 14
Type B 06/07/2019 Section Cited CCR 101216(f)	1 2 3 4 5 6 7	Personnel Requirements. At least one person trained in CPR and Pediatric first aid shall be present when children are at the facility or offsite activities. This requirement is not met as evidenced by: The Director could not provide LPA with current Pediatric CPR/1st Aid cards for herself or her Lead Teacher. The Director understands	1 2 3 4 5 6 7	The Director shall submit proof of completion of current Pediatric CPR/1st Aid certifications for herself and her Lead Teacher, who is alone with children, by the POC due date of 06/07/19.
	8 9 10 11 12 13 14	this is a potential risk to the children in care.	8 9 10 11 12 13 14

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: 05/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019

LIC809 (FAS) - (06/04)

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