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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415382
Report Date: 01/12/2023
Date Signed: 01/12/2023 06:29:06 PM


Document Has Been Signed on 01/12/2023 06:29 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:TINY TOTS PRESCHOOL AND CHILDCARE CENTERFACILITY NUMBER:
434415382
ADMINISTRATOR:HOIBERG, ELIZABETHFACILITY TYPE:
840
ADDRESS:8985 MONTEREY ROADTELEPHONE:
(408) 204-3832
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY:14CENSUS: 0DATE:
01/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elizabeth HoibergTIME COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Samantha Yip and Ashley Lopez conducted an unannounced Case Management- Other inspection. LPAs met with Director Elizabeth Hoiberg and explained the reason for the inspection. There were no school-age children present. Director stated that there were school-age children present in the morning in the breakfast.

LPAs observed at 10:05AM that there was a container of gasoline on top of the cubbies, which is accessible to children. LPAs also observed that there a bottle of Lysol toilet bowl cleaner underneath the bathroom sink of the children's bathroom.

There is a laundry room across the bathroom, which has a lock, but was not lock. The laundry room has cleaning supplies and laundry detergent. LPA discussed with Director about putting a lock on the door.

LPA also discussed with Director about updating parent handbook and sending the updated menu.

As a result of this inspection, a Type A and a Type B citation was issued. Exit interview conducted and report was reviewed with Director Elizabeth Hoiberg. A notice site visit was issued and must be posted for 30 days.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
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 4


Document Has Been Signed on 01/12/2023 06:29 PM - It Cannot Be Edited

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: TINY TOTS PRESCHOOL AND CHILDCARE CENTER
FACILITY NUMBER: 434415382

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/13/2023
Section Cited

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Building and Grounds. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.
This requirement is not met as evident by:
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Director moved container of gasoline and Lysol toilet bowl cleaner in the laundry room.
Director understands that the door to the laundry room needs to remain closed at times.
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Based on observation, LPAs observed that there was container of gasoline on top of the cubbies and bottle of Lysol toilet bowl cleaner under the bathroom sink, which is accessible to children. There is a laundry room across the bathroom, which has laundry detergent and cleaning supplies, which was not locked. This poses an immediate risk to children in care.
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Director send proof that the lock on the door or installed a latch.

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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
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: TINY TOTS PRESCHOOL AND CHILDCARE CENTER
FACILITY NUMBER: 434415382
VISIT DATE: 01/12/2023
NARRATIVE
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-----------------continuation of 809 dated 01/12/2023 page 1-----------------------

LPA Yip informed Director Elizabeth Hoiberg that this report dated 01/12/2023 documents one Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of the children in care.

Also, LPA Yip informed Director Elizabeth to provide a copy of this licensing report date 01/12/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the net day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be place in the child’s file for verification.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 01/12/2023 06:29 PM - It Cannot Be Edited

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: TINY TOTS PRESCHOOL AND CHILDCARE CENTER
FACILITY NUMBER: 434415382

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/19/2023
Section Cited

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Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child's authorized representative. Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the child's authorized representative and the Department upon request.
This requirement is not met as evident by:
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By 01/19/2023, Director will send updated menu.
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Based on interview and record review, facility does not have an updated menu, which poses a potential health and safety risk to children in care.
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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha YipTELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:
DATE: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/12/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4