434415577-11-5-2019-07-CC-SYIP-BHMTGX-20191105134352

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415577
Report Date: 11/05/2019
Date Signed: 11/05/2019 01:44:02 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: 3	DATE:	11/05/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Deepti Goomer		TIME COMPLETED:	11:30 AM

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 (LPAs) Samantha Yip and Marilou Monico conducted an unannounced annual random inspection. LPAs met with Director Kieu Nguyen and explained the reason for the inspection. Licensee Deepti Goomer arrived shortly after. Present during the inspection were 3 infants and at least 2 staff. The teacher child ratio was observed to be in compliance during today's inspection. LPA reviewed the sign in/sign out sheet, which contains full legal signature. License, Emergency Disaster Plan, and Notification of Parent's Rights were observed to be posted. LPAs toured the inside and outside of the facility. Facility does have a waive to commingle children in the morning & afternoon and to share outdoor space. The playground area is currently off-limits until repairs to play structure is completed. The facility was observed to be clean and sanitary. Disinfectants, cleaning supplies, and other items that are dangerous to children were stored inaccessible. Furniture and equipment, such as tables, chairs, napping mats, and cribs, were observed to be age appropriate and in good condition. There is sufficient amount of toys for the children in care. There is changing tables in the room, which is within arms reach of a sink. LPAs inspected the fridge used to store infant's food and bottles. Bottles and foods brought from home were labeled with the child's name and current date. Storage containers for waste have tight fitted lids. Licensee stated that there are no weapons, such as firearms, stored on the premise. LPA observed a fully charged fire extinguisher and smoke detector. The outdoor activity space is fenced. There are toys and equipment for the children. There were no bodies of water observed during today's inspection. Shaded rest area is provided through building over-hang. -------------------------continues on 809 dated 11/05/2019 page 2-----------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019

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: 11/05/2019

NARRATIVE

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-------------------continuation of 809 dated 11/05/2019 page 1-------------------------------------
Facility does provide meals and snacks to the children. Menu was observed to posted. Kitchen used to prepare snacks and meals were observed to be clean and sanitary. Drinking water is provided through Arrowhead bottle water.

A copy of the facility roster was obtained. 3 children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and needs and service plan. LPA reminded Licensee that needs and service plan need to be updated quarterly.

3 staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit and Mandated Reporter Training. LPAs discussed with Licensee about ensuring that staff are completing the Mandated Reporter Training for Child Care Providers and that requires renewal every 2 years. There is a staff with current CPR/1st Aid.

All staff present have cleared criminal records and child abuse index clearance. LPA also reminded Director 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.

Director stated that there are no children in care who require Incidental Medical Services (IMS). Plan for providing IMS is on file. 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.

Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

No deficiencies were cited as a result of today's inspection. An exit interview was conducted, where this report with Licensee. A NOTICE OF SITE VISIT WAS ISSUE AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2019

LIC809 (FAS) - (06/04)

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