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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412017
Report Date: 10/16/2019
Date Signed: 10/16/2019 12:02:49 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:OAK GROVE TAYLORFACILITY NUMBER:
434412017
ADMINISTRATOR:PALAK VYASFACILITY TYPE:
850
ADDRESS:410 SAUTNER DRIVETELEPHONE:
(408) 226-0462
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY:50CENSUS: DATE:
10/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Lozano, RosarioTIME COMPLETED:
12:15 PM
NARRATIVE
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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 50. Licensing staff met with acting director Lozano, Rosario. The program currently operates 9 AM to Noon, Monday thru Friday. Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. At 9 AM, 30 minutes into the site visit, there was a total census of 32 children all preschoolers, and a total staff of five, three teachers, one teachers assistant and one acting director. All areas identified on the Facility Sketch were inspected. The following was observed during the tour of the facility:

Physical Plant:
Portable 12A: The following was observed of this room during the inspection of the facility: Upon arrival, this room had 3 staff with 21 preschoolers; Two teachers and one teachers assistant. 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 Lozano, the isolation area is in the office. General sanitation was observed. Availability of indoor drinking water was observed in classroom. Disinfectants, cleaning solutions, medication and other hazardous items that pose a risk to children, were inaccessible to the children in care. Director Lozano states that poisons are locked in the staff bathroom closet. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition. Director Lozano states waste is to be discarded immediately after each meal. First Aid supplies were observed in the classroom in pouches. According to Director Lozano, 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 one Fire extinguisher size 3A40BC in this room and have been serviced on 06/22/2019. Teacher and child ratios were observed and staff names recorded. There is one sink and one drinking fountain. There are 3 tables with 21 chairs per table, all age appropriate. *****Page 1/4, Report Continued on Page 2*****

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

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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: OAK GROVE TAYLOR
FACILITY NUMBER: 434412017
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2019
Section Cited

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Criminal Record Clearance: Request and be approved for a transfer of a criminal record exemption, as specified in Section 101170.1(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility. This requirement was not met as evidenced by Staff 4 was not assocaited to this facility.
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 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: 10/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2019
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: OAK GROVE TAYLOR
FACILITY NUMBER: 434412017
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/16/2019
Section Cited

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Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code SectioFn 1596.871 shall prior to working, residing or volunteering in a licensed facility:(1)Obtain a California clearance or a criminal record exemption as required by the Department . This requirement was not met as evidenced by staff 5 did not have fingerprint clearance.
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This poses an immediate risk to the health and safety of the children in care.
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Type B
10/17/2019
Section Cited

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Reporting requirements: The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s). This requirement was not met as evidenced by LPA observed acting director did not report. This poses a potential risk to the health and safety of the childreb 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: 10/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2019
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: OAK GROVE TAYLOR
FACILITY NUMBER: 434412017
VISIT DATE: 10/16/2019
NARRATIVE
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All lavatories have appropriate water temperature, sufficient toilet paper, area safety and sanitation. LPA Almaraz observed soap dispenser and disposable towels. LPA Almaraz concludes, lavatory and all toilets/commodes and sink/washbasins are currently in compliance with licensing standards. . Age appropriate sinks and toilets/commodes were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation.

Playground: The following was observed of the playground: Outdoor equipment was inspected for safety, cushioning material, good repair 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. The children have access to drinking water during outside play. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed. Director Lozano states playground is shared with the preschool age special education program. LPA Almaraz concludes play ground is currently in compliance with licensing standards. The playground is also shared with the school district, school aged children. Schedule differentials and supervision acts as a deterrent from commingling preschool and school ages.



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. Sign-in and out sheets and procedures were reviewed, facility currently is in compliance. Personal Rights of children were observed by LPA Almaraz. Last fire/earthquake/disaster drill logged 09/26/2019.

Children’s Records were reviewed for completeness; Inspection of required forms was made. 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.

Staff records reviewed. Criminal Record Clearances were reviewed for adults. Staff 4 has a fingerprint clearance but has not been associated to this facility. Staff 5 has no fingerprint clearance. Acting Director qualifications checked. CPR card expires on 08/15/2020. Mandated Abuse Reporter Training taken. Director understands training is to be completed every two years.*****Page 3/4 Report Continued on Page 4*****

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

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 6 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: OAK GROVE TAYLOR
FACILITY NUMBER: 434412017
VISIT DATE: 10/16/2019
NARRATIVE
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 All records of education verified and immunization's checked for required documents. Director flu vaccine. Director states previous director is no longer employed with facility, this director is acting as director currently, and has been for three weeks. LPA Almaraz discussed the ten day reporting requirement of acting director and the 30 day limit to hire new director.

LPA advised Director 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. LPA informed Director 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.These forms may also be downloaded from our website: www.ccld.ca.gov

The following type A and B deficiencies were cited and civil penalties issued during todays inspection, noted on page 809D. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee/Director.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. *****Page 4/4, Final Page of Report*****

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

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
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: OAK GROVE TAYLOR
FACILITY NUMBER: 434412017
VISIT DATE: 10/16/2019
NARRATIVE
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Portable 12B: The following was observed of this room during the inspection of the facility: Upon arrival, this room had 1 staff, teacher with 11 preschoolers/toddlers; 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. 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 Lozano states that poisons are locked in the staff bathroom closet. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition. Director states waste is to be discarded immediately after each meal. First Aid supplies were observed in the classroom in pouches. Carbon monoxide detectors and smoke detectors are working presently in the facility. There is one Fire extinguisher size 3A40BC in this room and has been serviced on 06/22/2019. There are three tables with 24 chairs, all age appropriate. This room has one sink. LPA Almaraz concludes, this room is currently in compliance with licensing standards

Kitchen: There is a separate kitchen area in Portable 12B. Portables 12A and 12B are one room, separated into two parts. This area/food preparation area and food storage area is kept clean and are free of litter, and rubbish. There is one sink and one refrigerator in this area. LPA observed this area is currently in compliance with licensing standards. All storage containers in this area for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition.

Snack/lunch menus were reviewed. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Quarterly menus are available upon request. Snacks served daily. This is a three hour program therefore lunch is not served, only snacks.



Lavatories:
The following was observed of the lavatories during the inspection of the facility: These are located in Portable 12B. There are three lavatories beside the kitchen area. One used for staff and two for children. LPA observed lavatory including the sinks and commodes are accessible. There is one commodes and one sink per lavatory. *****Page 2/4, Report Continued on Page 3 *****
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2019
LIC809 (FAS) - (06/04)
Page: 2 of 6