434415093-8-25-2021-07-CC-JGSS-C68UX7-20210825155752

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415093
Report Date: 08/25/2021
Date Signed: 08/25/2021 03:57:57 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:	ROSEMARY INFANT CENTER		FACILITY NUMBER:	434415093
ADMINISTRATOR:	HEATHER ELSTON		FACILITY TYPE:	830
ADDRESS:	401 WEST HAMILTON AVENUE		TELEPHONE:	(408) 341-7127
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY:	16	CENSUS: 9	DATE:	08/25/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Heather Elston, Director		TIME COMPLETED:	04:07 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	#2 Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year inspection at the facility today. LPA met with Director, Heather Elston and explained the purpose of the visit today. LPA toured the inside and outside areas of the facility with the Director. All the required document materials were observed to be posted prominently. The teacher/child ratio was in compliance during today's inspection. The infant and napping rooms were observed to be in good order. Chemicals and cleaning supplies are stored on the high shelves that are inaccessible to children. The facility has a lock box that can be stored for any medication if needed. Play area and equipment were observed to be in good condition and safe for the children. Trash cans were observed with tight fitting lids for the disposal of solid wastes. Each infant has personal items individually stored and labeled. The facility has fire extinguisher, smoke and carbon monoxide detectors and first aid kit. The playground areas are surrounded by appropriate fencing and the outdoor surfaces are safe. The play equipment is age appropriate and in good condition. There is sufficient resilient materials in the outdoor playground area. The are no bodies of water observed. A copy of the children's roster was obtained. Five (5) children's and Six (6) staff files were reviewed during today's inspection. Children's 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 and care plan. Staff records reviewed include Immunization (Measles, Pertussis, and Flu) record, TB Clearance, CPR/First Aid and Mandated Reported Training, Curriculums and qualifications. Continued on next page.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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: ROSEMARY INFANT CENTER	FACILITY NUMBER: 434415093
	VISIT DATE: 08/25/2021

NARRATIVE

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Clearances for individuals at this facility who require caregiver background checks are issued by the State Department of Education and County office of Education and do not come under the jurisdiction of Community Care Licensing Division.

Facility provides Incidental Medical Services (IMS) and has a Plan of Operation that includes IMS that was submitted to the Department.

Care providers are encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources on Regulations, Adoptions of new laws, pay annual fees etc.

No deficiencies cited during today's inspection.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: James G Santos	TELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

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