434414738-10-4-2021-07-CC-PHEZ-C7GRKF-20211004130529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414738
Report Date: 10/04/2021
Date Signed: 10/04/2021 01:07:07 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:	BUTTERFLIES ACADEMY, INC		FACILITY NUMBER:	434414738
ADMINISTRATOR:	AZARCHEHR, FARINAZ		FACILITY TYPE:	850
ADDRESS:	14103 SARATOGA AVE.		TELEPHONE:	(408) 867-3772
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	30	CENSUS: 20	DATE:	10/04/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Farissa Azarchelr		TIME COMPLETED:	01:05 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), Pete Hernandez, met with Lead Teacher Farissa Azarchelr, for an unannounced Required 1 Year inspection. Owner/director, Farinaz Azarchehr was not at the facility during today's inspection. LPA toured the indoor and outdoor space of the Facility during today's inspection. 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), and Activity Schedule. The facility does have a waiver for a playground limited to 21 children at a time.. A review of staff records 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 reviewed 6 children's and two staff files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). All staff files reviewed contain the required transcripts/verification of experience. Farissa has current CPR and First Aid certifications. Farissa 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. Farissa understands the conditions, limitations, and capacity specifications of the Facility license. Farissa understands that children shall be visually supervised at all times. LPA observed that all rooms are clean and safe for all children and staff. Farissa states that the Facility has a third-party cleaning service that cleans the Facility once a week in the evenings. Drinking water indoor is via filtered water and cups. LPA observed solid waste containers with tight-fitting lids in the Facility. 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. Farissa states that there are no weapons or firearms on the premises. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 10/04/2021):

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

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: BUTTERFLIES ACADEMY, INC	FACILITY NUMBER: 434414738
	VISIT DATE: 10/04/2021

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 10/4/2021):

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 cabinets. Facility does not currently provide Incidental Medical Services (IMS).

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area is surrounded by appropriate fencing and the outdoor surfaces are safe. Shade is provided by a large tree and building overhang. There is a climbing structure in the playground. Drinking water outdoor is via water fountain and personal water bottles. The center will not provide transportation. There is a working telephone which is (408) 781-7874.

LPA reminded Farissa of the new Immunization Regulations SB 792, the requirement that all individuals working or volunteering at a licensed Child Care facility must have vaccinations against, Pertussis, Measles and Influenza. LPA advised Farissa that they can sign a declaration to be exempt from the influenza vaccinations however; Pertussis and Measles are not exemptible.

Licensee and staff do have current Mandated Reporter Certificates. LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with applicant Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: BUTTERFLIES ACADEMY, INC	FACILITY NUMBER: 434414738
	VISIT DATE: 10/04/2021

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Last fire drill was performed on 9/24/2021.

Farissa Azarchelr CPR and 1st aid certificate good until 2/21/202

TYPE A language: Should there ever be issuance of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, and a copy of this report was discussed and left with the Licensee, Farissa Azarchelr, whose signature on this form confirm receipt of these documents.

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

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: BUTTERFLIES ACADEMY, INC	FACILITY NUMBER: 434414738
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/04/2021 Section Cited	1 2 3 4 5 6 7	HEALTH & SAFETY CODE. Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. […]. The day care center shall maintain documentation of the required immunizations
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Staff 1 and Staff 2 has been working at the center, but the center does not have documentation that Staff 1 and Staff 2 do not have proof in their file is immunized against Measles, Pertussis and Influenza. This poses a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
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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: Sandy Knight	TELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro Hernandez	TELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC809 (FAS) - (06/04)

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