434414670-2-16-2022-07-CC-OCAO-CBPSQ8-20220216130418

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414670
Report Date: 02/16/2022
Date Signed: 02/16/2022 01:04:26 PM

Document Has Been Signed on 02/16/2022 01:04 PM - 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:	ACTION DAY PRIMARY PLUS		FACILITY NUMBER:	434414670
ADMINISTRATOR:	SCHROEDER, PAULA		FACILITY TYPE:	830
ADDRESS:	2174 LINCOLN AVENUE		TELEPHONE:	(408) 266-8188
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	50	CENSUS: 31	DATE:	02/16/2022
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:16 AM
MET WITH:	Jill Miller		TIME COMPLETED:	01:15 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 Analysts (LPAs) Ofelia Calivo and Marilou Monico met with Jill Miller, Preschool Director, for an unannounced Required 1-year inspection. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday 07:00 AM to 6:00 PM. Age serve is from birth to 24 months. LPAs toured the facility both indoor and outdoor. LPAs observed that the facility was operating in compliance with teacher to children ratio requirement. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Floors were clean. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on and were in good repair. Fire extinguisher, working smoke and carbon monoxide detectors were observed. LPAs observed that each infant has current feeding, diaper, and nap log. The center has documentation that sleeping infants were checked every 15 minutes. Diapers are being disposed appropriately. Each infant has personal items individually stored and labeled. Jill stated that there is no firearm in the facility. Drinking water is readily available for the children outdoor via bottles/sippy cups. They have shaded areas. The playground area is surrounded by appropriate fencing and the outdoor surfaces are safe. There were no bodies of water observed. Continuation on next pages:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

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 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: ACTION DAY PRIMARY PLUS	FACILITY NUMBER: 434414670
	VISIT DATE: 02/16/2022

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

LPAs reviewed 8 children's files. Children records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment, and Immunization. LPAs observed that all infants have an updated Infant Needs and Services Plan.

Eight (8) staff files were reviewed. Staff records reviewed include Criminal Record and Child Abuse Index Clearance, Transcripts of Records for teachers, Employee Rights (LIC 9052), Personnel Record (LIC 501), Health Screening Report with TB Clearance, Immunization (Measles, Pertussis, and Flu) record, and Mandated Reporter Training. LPAs reminded Site Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. LPAs observed at least one staff present during the inspection has current Pediatric CPR/First Aid certification.

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

LPA discussed the safe sleep regulations with Site Director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee 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.

Continuation on next page:

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

LIC809 (FAS) - (06/04)

Page: 2 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: ACTION DAY PRIMARY PLUS	FACILITY NUMBER: 434414670
	VISIT DATE: 02/16/2022

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

Site 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.

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/process.

As a result of this inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with the Site Director, Jill Miller.

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: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3