434415300-10-7-2021-07-CC-OCAO-C7L25F-20211007170529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415300
Report Date: 10/07/2021
Date Signed: 10/07/2021 05:05:37 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:	ENGENIUS LEARNING CENTER		FACILITY NUMBER:	434415300
ADMINISTRATOR:	IKEMOTO, DOUG		FACILITY TYPE:	840
ADDRESS:	1590 DRY CREEK ROAD		TELEPHONE:	(408) 446-1034
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	150	CENSUS: 27	DATE:	10/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Doug Ikemoto		TIME COMPLETED:	05:15 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 Doug Ikemoto, Director, for an unannounced Required 1-year inspection. The school age program is Licensed in Rooms #5, #6, #7, and #8 and the Library. The school age program hours of operation are Monday thru Friday from 6:30 AM to 8:30 AM and 2:00 PM to 6:00 PM. LPAs toured the facility both indoor and outdoor areas during today's inspection. The bathrooms are clean and working properly. Staff are using the bathroom located in the school office. First aid supplies are stored inaccessible to children. LPAs observed working smoke and carbon monoxide detectors. LPAs 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. A review of staff records on October 7, 2021 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPAs reminded Doug 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. LPAs reviewed ten children's and four staff files during today's inspection. LPAs reminded Site Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. Newly hired staff have 90 days to complete the Mandated Reporter Training. There is at least one staff in the Facility with current CPR and First Aid certifications on file. Doug 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). continuation on the next page

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

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: ENGENIUS LEARNING CENTER	FACILITY NUMBER: 434415300
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/08/2021 Section Cited	1 2 3 4 5 6 7	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. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Per record review, Staff #2 is missing immunization in measles, pertussis, and flu in the file. This poses a potential risk to the health and safety of the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

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: ENGENIUS LEARNING CENTER	FACILITY NUMBER: 434415300
	VISIT DATE: 10/07/2021

NARRATIVE

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Doug understands that the Facility must be in compliance with teacher/child ratio at all times. Doug understands the conditions, limitations, and capacity specifications of the Facility license. Doug understands that children shall be visually supervised at all times. There were 27 school age children present during today's inspection. Doug is aware of the required sign in and sign out procedures for school age children who arrive on their own. Doug states that all school age children are picked up by their parent(s)/guardian(s) and no children are allowed to leave the Facility on their own.

The Facility only provides afternoon snacks for the children. LPAs observed adequate snacks. Trash cans with tight-fitting lids are located throughout the facility for the disposal of solid waste. Cleaning supplies are stored in a high cabinets inaccessible to children.

The school age program is using the Kindergarten yard, the field area, and the elementary school yard for outdoor activity spaces. There is a climbing structure in the Kindergarten yard with resilient material to absorb falls. The playground equipment is age appropriate. Shade is provided by several large trees and building overhangs. LPAs observed no bodies of water. No transportation will be provided by the school. There are adequate equipment, supplies and toys for children both indoors and outdoors. Drinking water is provided indoors and outdoors via drinking fountains and individual water bottles. There is a working telephone at the facility. The phone number is (408) 785-1599.

LPA conducted an exit interview with Doug prior to the conclusion of today's inspection and advised him of the deficiency 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) 324-2128
LICENSING EVALUATOR NAME: Ofelia Calivo	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

LIC809 (FAS) - (06/04)

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