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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414670
Report Date: 11/02/2022
Date Signed: 11/02/2022 10:58:23 AM


Document Has Been Signed on 11/02/2022 10:58 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:ACTION DAY PRIMARY PLUSFACILITY NUMBER:
434414670
ADMINISTRATOR:SCHROEDER, PAULAFACILITY TYPE:
830
ADDRESS:2174 LINCOLN AVENUETELEPHONE:
(408) 266-8188
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:50CENSUS: 40DATE:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Stephanie BateTIME COMPLETED:
11:10 AM
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On November 2nd, 2022 at 8:30am, Licensing Program Analyst (LPA) Kassandra Medrano conducted a random annual licensing inspection. LPA met with Stephanie Bate, Director, the purpose of the visit was explained. The facility is an infant program and is located in Rooms 1 and 2. Days and hours of operation: Monday- Friday, 7am-6pm. LPA toured the facility building and grounds, conducted an evaluation of the physical plant, and reviewed children, staff and facility records. A review of staff records during today’s visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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. The facility has fully charged fire extinguishers that meet the minimum requirements, smoke detector, and a carbon monoxide detector in the facility. Facility is adequately furnished with age appropriate toys, furniture, cribs, changing tables, and equipment. Separate staff bathrooms are available. Outdoor play area was inspected for health and safety hazards; 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. If breast milk is provided by parents, it is stored appropriately in the refrigerator in an individualized bag and each bottle is labeled. Facility does not provide formula and diapers for children, parents provide lunches and diapers. Facility provides morning and afternoon snack. Sinks are present in the classroom as well as located near the changing tables. No pools, spas, hot tubs, fish ponds or similar bodies of water are present. Disinfectants, cleaning solutions, poisons, and toxins are inaccessible to children. Per staff, there are no firearms or weapons on site. Portable is set up for childcare and furniture and equipment for infant children is present. Adequate first aid supplies are available. Facility has posted all the required licensing forms in a prominent accessible location. LPA reviewed ten children's and 6 staff files during today's inspection.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ACTION DAY PRIMARY PLUS
FACILITY NUMBER: 434414670
VISIT DATE: 11/02/2022
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In the files that were reviewed, all children had a medical assessment and Infant Needs and Services Plan, and Infant Care feeding plan. In the staff files, all had criminal record clearance, personnel record, and a health screening with TB test.Staff have current Pediatric First Aid and CPR certification. Staff have the required immunization's and verification of the mandated child abuse reporting training as compliant with AB 1207. LPA reviewed with facility representative the LIC 311A, Records To Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted. The following items were reviewed as part of today's visit: Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Cleaning and sanitation practices of linens, toys and equipment used In the infant center, Transportation, Parents Rights, and Reporting Requirements. Posting requirements for site visits were also discussed as well as AB 633 requirements. Facility informed that effective September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed with director the Mandated Child Abuse Reporting training as compliant with AB 1207. As of January 1, 2018, all child care staff and volunteers are required to complete Mandated Child Abuse Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. Director was advised of the annual required pesticides training. For More information about changes to the Healthy Schools Act, templates, articles, and required training you can inspect the DPR website at: https://apps.cdpr.ca.gov/schoolipm/childcare/training/main.cfm LPA discussed the safe sleep regulations with the facility representative 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 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.
Current forms and Title 22 Regulations can be obtained through the internet at www.ccld.ca.gov
Incidental Medical Services (IMS) policy discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA is 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.
This report is reviewed with facility representative, Stephanie, and a copy of this report must be made available for public review upon request.

Notice of site visit posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
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