434412424-8-18-2023-07-CC-JCRZ-CUTPYT-20230818114429

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412424
Report Date: 08/18/2023
Date Signed: 08/18/2023 11:44:38 AM

Document Has Been Signed on 08/18/2023 11:44 AM - 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:	OAK GROVE - BALDWIN CHILD CARE CENTER		FACILITY NUMBER:	434412424
ADMINISTRATOR:	BUCCELLATO, JULIANA		FACILITY TYPE:	850
ADDRESS:	280 MARTINVALE LANE		TELEPHONE:	(408) 226-3370
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95119
CAPACITY:	40	CENSUS: 18	DATE:	08/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:31 AM
MET WITH:	Juliana Buccellato		TIME COMPLETED:	12:15 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) Janette Cruz met with Juliana Buccellato, Director and Melissa McFarland-Jimenez, Program Administrator for an unannounced Required- 1 Year inspection. LPA toured the indoor and outdoor areas of the facility during today's inspection. 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), and Activity Schedule. Oak Grove Baldwin Child Care Center is currently a licensed preschool program operating on a functioning elementary school site, Baldwin Elementary School. The preschool program is licensed to operate in portable classrooms, P1 and P2. .Days and hours of operations are Monday through Friday 7:30 AM to 3:30 PM. LPA reviewed children's files and staff files (director and teacher) during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and all required licensing forms. All staff files reviewed contain the required transcripts/verification of experience/immunization records, and Health Screening Report. LPA reviewed current certificates of completion of the Mandated Reporter Training for Child Care Workers and current CPR and First Aid certifications for staff on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during outdoor activities. Sign in and sign out sheets are in compliance. LPA observed that the teacher/child ratio was in compliance during today's inspection. Present during the inspection were 18 preschool children, three staff (program administrator, director and teacher). Director understands the conditions, limitations, and

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

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 5

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: 08/18/2023

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
26
27
28
29
30
31
32

capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the facility's office.

LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Director understands that the facility must be kept free of insects & rodents. LPA observed that all furniture and equipment are in good condition and safe for the children. LPA observed two rabbits in a secured cage inside the classroom. Drinking water is readily available for the children in the facility and in the outdoor playground area via water bottles labeled with each child's name. Staff and children's bathrooms are clean, sanitary, and in working order. Director states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors indoors upon close of inspection.

The food preparation and storage areas are clean, free of litter & rubbish, free of rodents and other vermin. There is also a hot and cold running water, refrigerator and microwave on the premises. Lunch is prepared and brought from home. The facility provides snacks to the children in care. Menu was posted. The kitchen used to prepare snacks was observed to be clean and sanitary. The Facility has trash cans with tight fitting lids for solid waste in the classroom. Cleaning supplies are inaccessible to the children and stored in high cabinets LPA observed a complete First Aid kit available in the facility.

The playground area 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. Shade rest areas are provided by trees. There is sufficient resilient materials (woodchips) on the outdoor playground area. LPA did not observe any bodies of water. Director states that the Facility does not provide transportation.

Director was reminded that all adults 18 and over, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: 08/18/2023

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
26
27
28
29
30
31
32

This 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. 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

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/inspection-process

LPA provided Director with website resources on managing food allergies at school and handling medical emergencies related to food allergies.

CDC Managing Food Allergies at School
https://www.cdc.gov/healthyschools/foodallergies/index.htm

American Academy of Pediatrics Healthy Children Medical Emergencies
https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/When-to-Call-Emergency-Medical-Services-EMS.aspx

Exit interview conducted and report was reviewed with Juliana Buccellato, Director and Melissa McFarland-Jimenez, Program Administrator. Deficiencies were cited and appeal rights given to Licensee representatives during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 08/18/2023 11:44 AM - It Cannot Be Edited

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: 08/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1596.954

Licensure Requirements

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above, there was no carbon monoxide detector available in the facility upon inspection which posed an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/21/2023
	Plan of Correction
1 2 3 4	Licensee installed carbon monoxide detectors during today's inspection.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 08/18/2023 11:44 AM - It Cannot Be Edited

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: 08/18/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above. Licensee did not have any documentation of lead testing conducted for drinking water at the facility, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/18/2023
	Plan of Correction
1 2 3 4	Licensee will submit to LPA Cruz documentation of conducted lead testing for facility's drinking water by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

LIC809 (FAS) - (06/04)

Page: 5 of 5