434412714-5-2-2019-07-CC-SYIP-BBSW2N-20190502165438

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412714
Report Date: 05/02/2019
Date Signed: 05/02/2019 04:54:46 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:	MORGAN HILL CHARTER AFTER SCHOOL PROGRAM		FACILITY NUMBER:	434412714
ADMINISTRATOR:	TINA BUSTAMANTE		FACILITY TYPE:	840
ADDRESS:	9530 MONTEREY AVENUE		TELEPHONE:	(408) 762-6000
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	50	CENSUS: 14	DATE:	05/02/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:37 PM
MET WITH:	Sophie Jaime		TIME COMPLETED:	05:00 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) Samantha Yip conducted an unannounced annual random inspection. LPA met with Site Director Sophie Jaime, who is subbing for Site Director Tina Bustamante. Facility is located on the Morgan Hill Charter School campus in Room 125. Present during the inspection were 2 staff and 14 children. All staff present are fingerprint cleared. LPA reviewed sign in/sign out sheet. License, Emergency Disaster Plan, and Notification of Parent's Rights were observed to posted. LPA toured the inside and the outside of the facility. Facility was observed to be clean and sanitary. All furniture, such as tables and chairs are age-appropriate and in good condition. LPA observed the restroom for children's use. Site Director stated that they have a third party who cleans the room. Disinfectants, cleaning solutions, and all other items that are dangerous to children were observed to be securely stored and inaccessible to children. Storage containers for waste have tight fitted lids. LPA observed that there is sufficient to age-appropriate toys for the children in care. LPA observed a fully charged fire extinguisher, carbon monoxide detector, and smoke detector. Director stated that there are no weapons, such as firearms, stored on premise. The facility uses the blacktop and the playground on the school campus. The outdoor space is fenced. The play structure has resilient materials to absorb falls. Shade is provided through trees and building overhang. LPA did not observe any bodies of water. Facility does provide snacks to the children in care. LPA inspected fridge and cabinet for snacks. Menu was observed to be posted. Drinking water is provided through gallon water bottle, which is transferred to a water cooler for children to use.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

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 3

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: MORGAN HILL CHARTER AFTER SCHOOL PROGRAM	FACILITY NUMBER: 434412714
	VISIT DATE: 05/02/2019

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

LPA reviewed 7 children files. The records reviewed include but not limited to the admission agreement and the parent's right notice.

LPA reviewed 1 staff file. The records reviewed include the immunization records and the Mandated Reporter Training. LPA observed that staff with CPR/1st Aid expired on 04/2019. Site Director understands that they should be at least one person with valid CPR/1st Aid at all time.

Site Director stated that she currently does not have any children in care who requires Incidental Medical Services (IMS) services.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.

LPA reminded Site Director about Reporting Requirements, such as notifying Licensing office if there is an outbreak of any communicable diseases.

In the areas evaluated today, a deficiency was cited as a result of today's inspection. An exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were discussed with Site Director Sophie.

A NOTICE OF SITE VISIT WAS ISSUE AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: MORGAN HILL CHARTER AFTER SCHOOL PROGRAM	FACILITY NUMBER: 434412714
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/02/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/03/2019 Section Cited CCR 101216(f)	1 2 3 4 5 6 7	Personnel Requirement. At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evident by:	1 2 3 4 5 6 7	By POC 06/03/2019, Site Director stated that she will send proof of CPR/1st Aid to Licensing office.
	8 9 10 11 12 13 14	Based on record review, Licensee failed to ensure that there is at least one staff present with a valid CPR/1st aid certificate, which poses a potential risk to the health and safety to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3