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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413697
Report Date: 06/28/2022
Date Signed: 06/29/2022 11:24:53 AM


Document Has Been Signed on 06/29/2022 11:24 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:RAINBOW CHILDHOOD DEVELOPMENT CENTERFACILITY NUMBER:
434413697
ADMINISTRATOR:HELEN QIUFACILITY TYPE:
830
ADDRESS:227 SOUTH MAIN STREETTELEPHONE:
(408) 781-8428
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:14CENSUS: 10DATE:
06/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:29 AM
MET WITH:Helen QiuTIME COMPLETED:
05:30 PM
NARRATIVE
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On Tuesday, June 28, 2022 10:30 AM, Licensing Program, Analyst (LPA) Manel Estoesta conducted an unannounced Required 1 Year visit. LPA met with the Director Helen Qiu and explained the nature of site visit. Present on this visit were 3 staff and 10 infant children. The facility operates from Monday to Friday 8:30 am to 5:30 pm.

LPA toured the facility and conducted a Health and Safety Inspection with the Director. Facility has an existing Preschool Program with Toddler Option (#434413698) in the same address. The Facility has an active waiver on file for sharing outdoor space. Facility is following posting requirements. Director stated that facility is using NO longer "ProCare" application for sign in and sign out.
At 11:30 AM, during the Children's Record Review, LPA observed that 3 out of 10 preschool children were not signed in by the parent. (See LIC 809 D.)
LPA observed that the infant room is clean and safe for all children and staff. LPA observed solid waste containers with tight-fitting lids in infant room. Staff and children's bathrooms are clean, sanitary, and operable. Infant room has a diaper changing table and is placed within arm's reach of a sink. There is a separate staff bathroom in the Infant Room not utilized by the children. The lobby is the isolation room. Director states that there are no weapons or firearms on the premises. LPA observed enough mats and cribs for the infants.
The facility provides lunch and snacks to the children once the infant can eat solid food, food is prepared in the kitchen. Parents provide formulas, diapers, wipes, and baby food. The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers. Cleaning supplies are inaccessible to the children and stored in high cabinets of the kitchen and staff bathroom inaccessible to children. Any medications at the Facility are stored in the office.

See 809 C
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022
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 13


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: RAINBOW CHILDHOOD DEVELOPMENT CENTER
FACILITY NUMBER: 434413697
VISIT DATE: 06/28/2022
NARRATIVE
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Continuation....

LPA observed that the infant play equipment is age appropriate and in good condition.

At 11:30 AM, LPA reviewed children records and at 1:30 PM LPA reviewed Staff Records.

Individual Medical Services (IMS) policy was discussed. This facility provides IMS to children in care. Facility is following IMS plan on file. When any changes to the IMS plan is made, an updated Plan for Providing IMS must be submitted to the Department. 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.

Licensee 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.


LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.
SEE 809 C.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC809 (FAS) - (06/04)
Page: 2 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: RAINBOW CHILDHOOD DEVELOPMENT CENTER
FACILITY NUMBER: 434413697
VISIT DATE: 06/28/2022
NARRATIVE
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Continuation....

LPA discussed the PIN 20-24 CCP, PIN 21-21 CCP, PIN 22-10 CCP and LIC 311 A. The Director understood.

At 1:30 PM, during the Staff Record Review, LPA observed that Staff number 3, 5 and 6 is not associated with the facility. Staff number 5 is no longer working in the facility as per the Director's statement. (SEE LIC 809 D.)

A notice of site visit was given and must remain posted for 30 days.

LPA Estoesta informed licensee / Director Helen Qiu that this report dated 06/28/2022 with Type A and B citation shall be posted for 30 consecutive days as there is immediate risk and potential risk to the health, safety, or personal rights of children in care.

Also, LPA Estoesta informed the licensee to provide a copy of this licensing report dated 06/28/2022 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the licensee / Director, Helen Qiu.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC809 (FAS) - (06/04)
Page: 3 of 13
Document Has Been Signed on 06/29/2022 11:24 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: RAINBOW CHILDHOOD DEVELOPMENT CENTER
FACILITY NUMBER: 434413697

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)(2)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 9 were not associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/29/2022
Plan of Correction
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The Director provided a copy of the Staff's 4 and 6 Driver's License ID, LIC 9182 and LIC 508 to the LPA during the visit. The Director will conduct a staff meeting on or before 07/13/22 and include watching the Child Care Licensing Videos - Child Care Center Operators. The Director will submit to LPA the attendance of the meeting with staff signatures. LPA provided the website to the Director regarding the videos.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022
LIC809 (FAS) - (06/04)
Page: 4 of 13


Document Has Been Signed on 06/29/2022 11:24 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: RAINBOW CHILDHOOD DEVELOPMENT CENTER
FACILITY NUMBER: 434413697

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(a)
Sign In and Sign Out
(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in, at 11:30 PM, during the Children's Record Review, LPA observed that 3 out of 10 were not signed In by the parent.
which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2022
Plan of Correction
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The Director will require the Parent's to sign in and out the 11 out of 20 that were not signed on 6/28/22. The Director will create a plan on Sign In and Out procedure and will send a copy to LPA on or before the POC date. The Director will conduct a staff meeting on or before 07/13/22 and include watching the Child Care Licensing Videos - Child Care Center Operators. The Director will submit to LPA the attendance of the meeting with staff signatures. LPA provided the website to the Director regarding the videos.
Type B
Section Cited
CCR
101229.1(a)(1)
Sign In and Sign Out
(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review the licensee did not comply with the section cited above in, at 11:30 PM, during the Children's Record Review, LPA observed that 3 out of 10 were not signed In by the parent.
which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2022
Plan of Correction
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The Director will require the Parent's to sign in and out the 11 out of 20 that were not signed on 6/28/22. The Director will create a plan on Sign In and Out procedure and will send a copy to LPA on or before the POC date. The Director will conduct a staff meeting on or before 07/13/22 and include watching the Child Care Licensing Videos - Child Care Center Operators. The Director will submit to LPA the attendance of the meeting with staff signatures. LPA provided the website to the Director regarding the videos.

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: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022
LIC809 (FAS) - (06/04)
Page: 5 of 13


Document Has Been Signed on 06/29/2022 11:24 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: RAINBOW CHILDHOOD DEVELOPMENT CENTER
FACILITY NUMBER: 434413697

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101229.1(c)
Sign In and Sign Out
(c) A person who removes the child from the center during the day, and returns the child to the center the same day, shall sign the child in/out.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review the licensee did not comply with the section cited above in, at 11:30 PM, during the Children's Record Review, LPA observed that 3 out of 10 were not signed In by the parent.
which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2022
Plan of Correction
1
2
3
4
The Director will require the Parent's to sign in and out the 11 out of 20 that were not signed on 6/28/22. The Director will create a plan on Sign In and Out procedure and will send a copy to LPA on or before the POC date. The Director will conduct a staff meeting on or before 07/13/22 and include watching the Child Care Licensing Videos - Child Care Center Operators. The Director will submit to LPA the attendance of the meeting with staff signatures. LPA provided the website to the Director regarding the videos.
Type B
Section Cited
CCR
101229.1(d)
Sign In and Sign Out
(d) The sign-in and sign-out sheets with the signatures required by this section and by Section 101226.1 shall be kept for one month and shall be available at the center for review by the Department.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on record review the licensee did not comply with the section cited above in, at 11:30 PM, during the Children's Record Review, LPA observed that 3 out of 10 were not signed In by the parent.
which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/13/2022
Plan of Correction
1
2
3
4
The Director will require the Parent's to sign in and out the 11 out of 20 that were not signed on 6/28/22. The Director will create a plan on Sign In and Out procedure and will send a copy to LPA on or before the POC date. The Director will conduct a staff meeting on or before 07/13/22 and include watching the Child Care Licensing Videos - Child Care Center Operators. The Director will submit to LPA the attendance of the meeting with staff signatures. LPA provided the website to the Director regarding the videos.

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: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022
LIC809 (FAS) - (06/04)
Page: 6 of 13