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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412424
Report Date: 08/15/2019
Date Signed: 08/15/2019 04:14:49 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 - BALDWIN CHILD CARE CENTERFACILITY NUMBER:
434412424
ADMINISTRATOR:BUCCELLATO, JULIANAFACILITY TYPE:
850
ADDRESS:280 MARTINVALE LANETELEPHONE:
(408) 226-3370
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY:40CENSUS: 0DATE:
08/15/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Buccellato, JulianaTIME COMPLETED:
04:20 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Almaraz, Araceli and Cervantes, Susy and Licensing Program Manager (LPM) Segura, Mary conducted an annual random inspection. LPAs and LPM met with Directors Bucellato, Juliana and Mcfarland-Jimenz, Melissa, and explained the nature of today's inspection. There were no children present. Director Juliana advised that children are currently enrolled but class will not start until 08/19/2019. Licensing staff toured the class rooms, check equipment, toys and materials used by children. Toured bathrooms were toured, all sinks and toilets are functional. There are three sinks and three toilets available for staff and children at this facility, this includes classrooms P1 and P2. Toured gated kitchen, checked all utensils, drawers, cabinets and storage areas. Refrigerator was functioning, freezer temperature 0 degrees and refigerator was at 40 degrees F..There is a 3A40BC fire extinguisher in each class room last serviced in 06/19/2019. Last fire drill conducted 06/03/2019. There is a working Smoke/Carbon Monoxide Detector.
Facility was granted a license for a capacity of 40 01/24/2018. As it was observed that there are only sufficient toilets, sinks for a licensed for a capacity of 30. Classrooms P1 and P2 were remeasured to determine what in door space is available. The following are the measurements that were taken:
P1 29.6 X 22.10=654.16 FT encumbered space 57.782 FT
P2 29.4X22.10=649.74 FT
With a total of indoor space: 654.16+649.74=1303.9 minus encumbered space.57.782=1246.118
1246.118 divided by 35=35.603 Children.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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 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: OAK GROVE - BALDWIN CHILD CARE CENTER
FACILITY NUMBER: 434412424
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2019
Section Cited
HSC
1596.866(b)(1)
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Health and Safety: On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Director will submit proof of completion to LPA on or before 09/30/2019 via, fax, mail, email or text photo.
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This requirement was not met as evidenced by licensing staff observed center failed to maintain records for S4 did not have proof of completion of AB1207. This poses a potential risk to the health and safetr of the children in care.
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Type B
09/16/2019
Section Cited
HSC
1596.7995(a)(1)
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Health and Safety Code: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement was not met as evidenced by licensing staff observed S1 and S2 did not have records of immunizations. This poses a potential risk to the health and safety of the children in care.
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Director will submit proof of measules, pertusis and flu shots for S2 to LPA on or before 09/30/2019 via, fax, mail, email or text photo.
Type B
09/16/2019
Section Cited
CCR
101215.1(m)
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Child Care Center Qualifications and Duties: A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866. This requirement was not met as evidenced licesning staff observed S1 and S3 failed to meet this requirement. There was no record of health and safety training on file. Thsi poses a potential risk to the health and safety of the children in care.
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Director will submit proof of completion for S1 and S3 for 8 hours on or before 09/16/2019 t oLPA via fax, mail, email and/or text photo.
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: 08/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
LIC809 (FAS) - (06/04)
Page: 2 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: OAK GROVE - BALDWIN CHILD CARE CENTER
FACILITY NUMBER: 434412424
VISIT DATE: 08/15/2019
NARRATIVE
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Outdoor measurements:
(176.4X103.6) divided by 2=9137.52
(104X166.5) divided by 2=8658
9137.52+8658=17795.52 minus encumbered space 81.81=17713.71 divided by 75=236.1828 children.

Based on indoor space and outdoor space, sinks and toilets available, maximum capacity for this facility should be 30 children. This was discussed with the director Mcfarland-Jimenez, Melissa Director will be submitting an LIC 200A to reduce capacity to 30 children.

The following Type B Deficiencies were observed and documented on the 809 D pages: Licensing staff reviewed staff records and completed teacher and director qualifications.

Licensing staff conducted an exit interview with Mcfarland-Jimenez, Melissa and reviewed the Type B deficiencies and went over the plan of corrections. Notice of Appeal rights were given to Director Mcfarland-Jimenez, Meslissa.

A review of staff records on 08/13/2019 indicates that Staff 1, 2,4 and 5 who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Staff 3 has inactive fingerprints in the system, have been submitted via live scan. Staff 3 will not be present at the facility when children are present until such time, staff 3 obtains a criminal records clearance and/or exemption. Licensing staff reminded director Mcfarlland-Jimenez, Melissa 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 violation within a 12-month period.

NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.



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

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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: OAK GROVE - BALDWIN CHILD CARE CENTER
FACILITY NUMBER: 434412424
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2019
Section Cited
CCR
101216(g)(1)
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Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement ws not met as evidenced by licensing staff observed S1 failed to have this on record. This poses a potential risk to the health and safety of the children in care.
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Director will submit proof of completion for TB and health screening for S1 on or before 09/16/2019 to LPA via fax, mail, email and/or text photo.
Type B
09/16/2019
Section Cited
CCR
101216.1(c)(1)
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(c) To be a fully qualified teacher, a teacher shall have one of the following:
Teacher Qualifications: Twelve postsecondary semester or equivalent quarter units in early childhood education or child development completed, with passing grades, at an accredited or approved college or university; and at least six months of work experience in a licensed child care center or comparable group child care program. This requirement was not met as evidenced by licensing staff observed the documention was not on file for S5. This poses a potential risk to the health and safety of the children in care.
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Director will submit proof of documentation for S5 on or before 09/16/2019 t oLPA via fax, mail, email and/or text photo.
Type B
09/16/2019
Section Cited
CCR
101216.1
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Teacher Qualifications: To be a fully qualified teacher, a teacher shall have one of the following: at least six months of work experience in a licensed child care center or comparable group child care program. The units specified in (c)(1) above shall include courses that cover the general areas of child growth and development, or human growth and development; child, family and community, or child and family; and program/curriculum. Experience shall be verified as having been performed satisfactorily, at least three hours per day for a minimum of 50 days in a six-month period,. .
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This requirement was not met as evidenced by facility failed t omaintain doucmentation for S2, S4 and S5. This poses a potentail risk to the health and safety of the chlldren in care.
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Director will submit proof of documentation for S2, S4 and S5, for work experience on or before 09/16/2019 t oLPA via fax, mail, email and/or text photo.
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: 08/15/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4