434413759-1-22-2020-07-CC-MSMS-BL3S4B-20200122123227

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413759
Report Date: 01/22/2020
Date Signed: 01/22/2020 12:32:34 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:	BOOST UP KIDS ACADEMY		FACILITY NUMBER:	434413759
ADMINISTRATOR:	JYOTI DAWRA		FACILITY TYPE:	850
ADDRESS:	743 S WOLFE ROAD		TELEPHONE:	(408) 732-2200
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY:	86	CENSUS: 68	DATE:	01/22/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Bhawna Patkar		TIME COMPLETED:	12:45 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), Mel Matos met with Bhawna Patkar, Licensee representative/ director, for an unannounced annual/random inspection. LPA toured the Facility both inside and outside during today's inspection. LPA notes that the Facility is licensed in the Two's, Three's (2), and Four's (2) Rooms. 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), Menus, and Activity Schedule. The Facility has two active waivers on file (playground and electronic sign in and out) and is in compliance with the conditions of both waivers. A review of staff records on January 22, 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 reminded Bhawna 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. LPA reviewed ten children's files and seven staff (6 teachers and 1 aide) files during today's inspection. Each child's file reviewed contains a copy of the Information and Emergency Information form (LIC 700) and admission agreement. All staff files reviewed contain the required transcripts/verification of experience and proof of completion of the Mandated Reporter Training for Child Care Workers. All staff have current CPR and First Aid certifications on file. Bhawna understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). LPA observed that the teacher/child ratio was in compliance during today's inspection. Bhawna understands the conditions, limitations, and capacity specifications of the Facility license. Bhawna understands that children shall be visually supervised at all times. LPA observed 9 preschool children with 1 teacher in the Two's Room, 12 preschool children with 1 teacher in the Three's Room, 12 preschool children with 1 teacher in the second Three's Room, 15 preschool children with 1 teacher and 1 aide in the Four's Room and 20 preschool children with 2 teachers in the second Four's Room. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 01/22/2020):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

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 2

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: BOOST UP KIDS ACADEMY	FACILITY NUMBER: 434413759
	VISIT DATE: 01/22/2020

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

CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 01/22/2020):

LPA observed that all rooms are clean and safe for all children and staff. Bhawna states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Drinking water is readily available for the children in each room and in the outdoor playground area via drinking fountains and water coolers/disposable cups. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Bhawna states that there are no weapons or firearms on the premises. The Facility has at least one or more functioning carbon monoxide detectors on site.

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 at 45 degrees F or less. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Bhawna states that the Facility does not administer any medications.

LPA observed all furniture and equipment is in good condition and safe for the children. 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. There is sufficient resilient materials in the outdoor playground area. LPA did not observe any bodies of water.

Licensing Forms, Title 22 Regulations and information can be obtained through the internet at www.cdss.ca.gov.

LPA conducted an exit interview with Bhawna prior to the conclusion of today's inspection and advised her no deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2