434413390-2-26-2020-07-CC-FCJO-BM72RG-20200226163732

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413390
Report Date: 02/26/2020
Date Signed: 02/26/2020 04:37:37 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:	SAFARI KID - EVERGREEN		FACILITY NUMBER:	434413390
ADMINISTRATOR:	SAFARI KID - EVERGREEN		FACILITY TYPE:	850
ADDRESS:	4868 SAN FELIPE RD SUITE 130		TELEPHONE:	(408) 532-1283
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	82	CENSUS: 19	DATE:	02/26/2020
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Neena Billimoria		TIME COMPLETED:	04:45 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), Fermin Campos-Jaramillo made an unannounced annual required inspection to the center today. LPA met with Neena Billimoria, Site Director, and explained the nature of today's inspection to her. Also present during the inspection was Ms. Jaishree Chitkara owner of the center. LPA observed 19 children were in care today, children were at nap time at the time of LPA arrived. LPA observed there were two staff members taking care of the children. LPA observed that more than one member of the staff present has a valid CPR/First Aid certifications. LPA observed posted the forms required by this Licensing Department. The center has an active waiver allowing parents to sign children electronically in and out with a PIN or a bar code. LPA toured the facility inside and outside. Staff and children's toilets and sinks are safe and in sanitary operating conditions. LPA observed the storage areas are clean and free of litter. LPA observed disinfectants, cleaning solutions, sharp objects, and other similar items are stored inaccessible to children. LPA observed there is a first aid kit inaccessible to children. Site Director stated the center does not provide food or snacks to children. LPA observed the facility has functioning smoke detectors and some fire extinguishers type 3A40BC last serviced on March 2019. LPA observed that drinking water is readily available indoor via water fountain and water bottles that children bring from home. LPA observed there are trash cans with tight fitting covers for the disposal of solid waste. LPA observed the center has at least one working Carbon Monoxide detector. Site Director stated that there are no weapons in the premises. The outdoor areas are surrounded with appropriate fencing and not bodies of water. LPA observed that all furniture, equipment and playground equipment is safe and in good conditions, free of sharp, loose, or pointed parts. LPA observed that shade in the playground is provided by umbrellas, trees and building overhang. ************************REPORT DATED 2/26/2020 CONTINUES ON PAGE #2

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020

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: SAFARI KID - EVERGREEN	FACILITY NUMBER: 434413390
	VISIT DATE: 02/26/2020

NARRATIVE

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Report dated 2/26/2020 continues from page 1.

LPA observed that outdoors water is provided via water fountains and water bottles. LPA observed there is rubber mulch as resilient material under the climbing structure in the playground. LPA observed all floors were clean and safe.
LPA observed that a fire drill was documented on 1/17/2020. LPA reviewed the sign-in, sign-out sheets and are signed with full signatures. Site Director stated there are records in each personnel file documenting the educational background of the staff.
LPA reminded Licensee 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. A review of staff records on 2/24/2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded Licensee 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.
Site Director stated there is one child under medication currently enrolled in the center.
For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department.

LPA observed that staff have obtained proof of completion of the mandated reporter training AB1207. Licensee understands that training is mandatory for teachers and all the adults in contact with the children in care. Site Director understands the training shall be renewed every two years. LPA referred Site Director to the training website: www.mandatedreporterca.com for additional information on the online training. LPA observed that all the staff members present today have proof of immunization for measles, pertussis and influenza in file in compliance with the SB792.

No deficiencies were cited during today's inspection. Exit interview was conducted with Ms. Jaishree Chitkara. LPA provided Ms. Chitkara with the notice of site visit which has to be visible posted for the following 30 consecutive days.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-Jaramillo	TELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020

LIC809 (FAS) - (06/04)

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