434415577-8-22-2019-07-CC-SYIP-BFASSR-20190822140823

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415577
Report Date: 08/22/2019
Date Signed: 08/22/2019 02:08:28 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:	GOOMER ACADEMY		FACILITY NUMBER:	434415577
ADMINISTRATOR:	DEEPTI GOOMER		FACILITY TYPE:	830
ADDRESS:	16560 MONTEREY ROAD		TELEPHONE:	(408) 507-3201
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY:	16	CENSUS: 0	DATE:	08/22/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:01 AM
MET WITH:	Deepti Goomer		TIME COMPLETED:	01:10 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 (LPA) Samantha Yip, Nancy Rodriguez and Licensing Program Manager (LPM) Tony Studebaker conducted an announced Prelicensing inspection. LPAs and LPM met with Applicant Deepti Goomer and explained the reason for the inspection. Applicant is applying for a change of ownership. The address, 16560 Monterey Road, Morgan Hill 95037, is currently licensed under #434415168 and #434415169. Applicant is requesting for a capacity of 16 infants. The hours of operation are 6:30AM to 6:30PM. LPA toured in the inside and outside of the facility. A fire clearance for 16 infants was granted on 08/20/2019. The measurement for the inside are as followed: Room 1: 8.4179X 8.750 = 73.649 sq. ft. .167 X 16.083 = 308.262 sq. ft. 14.583 X 2.000 = 29.166 sq. ft. 14.167 X 4.667 = 66.117 sq. ft. - 23.998 sq. ft. (encumbered) = 42.119 sq. ft. 2.583 X 1.058 = 2.733 sq. ft. 8.750 X 13.167 = 115.211 sq. ft. - 2.500 sq. ft. (encumbered) = 112.711 sq. ft. *TOTAL INDOOR SPACE: 568.640 sq. ft. divided by 35 = 16 infants.* ------------continues on 809 dated 08/22/2019 page 2------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

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: GOOMER ACADEMY	FACILITY NUMBER: 434415577
	VISIT DATE: 08/22/2019

NARRATIVE

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--------------continuation of 809 dated 08/22/2019 page 2---------------------

Applicant stated that she does plan of providing Incidental Medical Services (IMS). Applicant stated that she will submit a Plan for Providing Incident Medical Services to Licensing office. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was 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.

LPM discussed with Applicant about supervision of children and capacity options. LPM also discussed with Applicant about staffing. Applicant understands that children’s personal rights should not be violated; including no corporal punishment. LPM also discussed with Applicant about Need and Service Plan for infants and that it needs to be updated quarterly.

LPA discussed about immunization records for pertussis and measles for all staff and 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. Mandated Reported Training can be accessed at http://www.mandatedreporterca.com.

LPA informed Applicant 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 violation within a 12 month period.

LPA discussed and provided Applicant with Safe Sleep. LPA also provided Applicant with Lead Exposure pamphlet.

An exit interview was conducted with Applicant and Applicant was informed that upon approval of Licensing Management, a license for an infant child care center will be granted and issued to Applicant upon completion of submitting requested documents.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

LIC809 (FAS) - (06/04)

Page: 3 of 3

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: GOOMER ACADEMY	FACILITY NUMBER: 434415577
	VISIT DATE: 08/22/2019

NARRATIVE

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-----------continuation of 809 dated 08/22/2019 page 1---------------------------

The outdoor activity space measures are as followed:
Playground 2- 59.417 X 25.167 = 1,495.348 sq. ft. - 61.002 sq. ft. (encumbered) = 1,434.346 sq ft
17.500 X 4.417 = 77.298 sq. ft.
13.000 X 4.083 = 53.079 sq. ft.

TOTAL OUTDOOR SPACE: 1,564.723 sq. ft. divided by 75 = 20 children.

The outdoor activity area has appropriate fencing. LPA observed there is sufficient amount of play equipment and toys. LPA reminded Applicant about sweeping the playground for any broken pieces or cracks in the play equipment, such as bikes. Shaded rest area are provided through building overhang. There were no bodies of water observed during today's inspection. Applicant has submitted a waiver request to share outdoor activity space.

There are 6 chairs, 1 table, 6 cribs, 6 napping mats, and 18 cubbies. There is a changing table in the room, which has appropriate siding and padding. Changing table is within arms reach of a sink. Storage container have a tight fitted lid. There is sufficient amount of age appropriate toys for the children in care. LPA observed a fully charged fire extinguisher and smoke detector. Applicant stated that there are no weapons, such as firearms, stored in on the premise. Applicant will be using office to isolate sick children.

Applicant stated that she will providing meals and snacks to the children in care. Drinking water is provided through individual water bottles. LPA reminded Applicant that any food or bottles brought from home need to be labeled with the child's name and current date.

--------------continues on 809 dated 08/22/2019 page 3------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019

LIC809 (FAS) - (06/04)

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