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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412405
Report Date: 07/20/2023
Date Signed: 07/20/2023 02:49:25 PM

Document Has Been Signed on 07/20/2023 02:49 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:GOOMER ACADEMYFACILITY NUMBER:
434412405
ADMINISTRATOR:DEEPTI GOOMERFACILITY TYPE:
850
ADDRESS:2920 FOWLER ROADTELEPHONE:
(408) 270-2000
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 74TOTAL ENROLLED CHILDREN: 63CENSUS: 49DATE:
07/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Deepti GoomerTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Marilou Monico and Farida Raja met with Program Director, Deepti Goomer, for an unannounced Required - 1 Year Inspection. The purpose of today's visit was explained with Deepti. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 07:00 AM to 6:00 PM. The facility is licensed to serve children ages 2 years to entry into first grade.

LPAs toured the indoor and outdoor areas. LPAs observed that the teacher-child ratio was in compliance. Fire drill was conducted on June 8, 2023. The facility has current children's roster and copy was provided to LPAs during the inspection. Cleaning products, disinfectants, sharp objects were stored inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The facility is clean. The bathrooms for children and staff are clean, sanitary, and operable. LPAs observed six toilets and 10 sinks available for the children. Program Director stated that the center has a third party cleaning service that comes after daycare hours to clean the facility.

The center provides breakfast, morning snacks, lunch, and afternoon snacks to the children. There is a kitchen at the facility adjacent to Room 3. The kitchen is equipped with refrigerator, stove, microwave, dishwasher, and a sink with hot and cold running water. Drinking water is available for the children indoor via individual water bottles. LPAs observed trash cans with tight fitting covers for the disposable of solid wastes. The facility has fire extinguishers and working smoke and carbon monoxide detectors.

The playground is surrounded with appropriate fencing and the outdoor surfaces are safe. Shade is provided by trees, canopy, and building overhang. Drinking water is readily available for the children outdoor via individual water bottles. There are climbing structures in the playground with rubber foam as resilient material under and around the structures. There were no bodies of water observed. Deepti stated that there are no weapons or firearms on the premises.
Continuation on next pages:
Joel Segura
Marilou Monico
DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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: GOOMER ACADEMY
FACILITY NUMBER: 434412405
VISIT DATE: 07/20/2023
NARRATIVE
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LPAs reviewed 10 random children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment, Physician's Report, TB test, Parent Right's Receipt, Personal Rights, and Child Preadmission Health History.

LPAs reviewed eight (8) staff files. Staff records reviewed include Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza) and required training. LPAs reminded Program Director that the Mandated Reporter Training shall be renewed by all staff every two years. LPAs observed that all staff have current Pediatric CPR/First Aid certifications.

This facility provides Incidental Medical Services (IMS). LPAs 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. 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.

Program Director, Deepti, was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then 5-years after the date of the first test.

LPAs verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

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SUPERVISOR'S NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
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: GOOMER ACADEMY
FACILITY NUMBER: 434412405
VISIT DATE: 07/20/2023
NARRATIVE
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Program Director, Deepti, was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

The following items to be sent to Licensing by August 4, 2023:
1) Updated Emergency Disaster Plan (LIC 610) together with permission letter from relocation sites

As a result of this inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with Program Director, Deepti Goomer.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2023
LIC809 (FAS) - (06/04)
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