434412402-6-15-2022-07-CC-PHEZ-CFESV9-20220615141222

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412402
Report Date: 06/15/2022
Date Signed: 06/15/2022 02:12:35 PM

Document Has Been Signed on 06/15/2022 02:12 PM - It Cannot Be Edited

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:	SCUTTLEBUGS CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	434412402
ADMINISTRATOR:	LINDA WHITE		FACILITY TYPE:	830
ADDRESS:	3291 STEVENS CREEK BLVD		TELEPHONE:	(408) 564-5356
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95117
CAPACITY:	38	CENSUS: 14	DATE:	06/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:42 PM
MET WITH:	Linda White		TIME COMPLETED:	02:30 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), Pete Hernandez, met with Center Director, Linda White for an unannounced Required 1 Year Inspection in the Infant Program. The Facility is currently licensed in Infant Room 1 and Toddler Room 1. The facility has three waivers on file for shared indoor gym, shared restrooms and the electronic sign in out. 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. LPA observed (9) infants with three (3) Teachers in the infant room and (5) Toddlers with two (2) Teachers In the Toddler Room 1. (Licensee no longer has a Toddler Option.) LPA toured the indoor and outdoor areas of the Facility during today's inspection. LPA observed that all rooms are clean and safe for all children and staff. Mrs White states that the facility has an outside janitorial company that clean the facility Monday through Friday in the evenings. Drinking water is readily available for the children in each room and in the outdoor playground area via water pitchers and disposable cups or personal bottles. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Mrs. White states that there are no weapons or firearms on the premises. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06/15/2022):

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022

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: SCUTTLEBUGS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434412402
	VISIT DATE: 06/15/2022

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 6/15/2022):

The facility provides AM and PM snacks. Parents do provide food. Storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children. Any medications at the Facility are stored in the classroom and are inaccessible to children in care.

LPA reviewed 5 staff files during today's inspection. A review of staff records on 6/15/2022 indicates that all individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded the Center Director 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. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12-month period. All teacher files reviewed contain the required transcripts/verification of experience. Mrs. White understands the conditions, limitations, and capacity specifications of the Facility license. Mrs. White understands that children shall be visually supervised at all times. And that a teacher or aide is required to be present in the nap room any time a child is placed in the room. LPA observed one teacher in the nap room with three infants.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground areas utilized by children 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. There is sufficient resilient material on the outdoor playground areas. LPA did not observe any bodies of water.

Licensee has an IMS plan on record.

LPA obtained an updated Facility Roster.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022

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: SCUTTLEBUGS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434412402
	VISIT DATE: 06/15/2022

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 06/15/2022):
Last fire drill was done 5/27/22. LPA informed Licensee that fire/disaster drills must be practiced at least once every six months and documented. Licensee is compliant.

LPA went over Reg 102425(j) and (j)(2)(D) regarding infant care and LIC 9227 (Infant Sleeping Plan). LPA Provided a copy. The provider shall supervise infants while they are sleeping. Linda is currently compliant with these.

Director White and all infant staff have current Mandated Reporter certificates.

Director Linda White has current CPR and First Aid Certificate. Linda's expires on 8/21/23. At least one staff member on site has a current CPR and First Aid certification on file. Mrs White understands that there shall be at least one person, with valid CPR and First Aid certifications, on site.

LPA reviewed the files of 10 children and they all contained the required documentation.

LPA reviewed the files of 5 staff and all the files contained the required documentation.

TYPE A language: Should there ever be issuance of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is not being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, and Plan of Corrections were reviewed and developed with the licensee. A copy of this report and appeals rights were discussed and left with the Licensee, Linda White, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022

LIC809 (FAS) - (06/04)

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