434415602-1-21-2021-07-CC-MSMS-BXGUYM-20210121150011

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415602
Report Date: 12/30/2020
Date Signed: 01/21/2021 03:01:11 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:	PEPPERTREE SCHOOLS RANCH HOUSE		FACILITY NUMBER:	434415602
ADMINISTRATOR:	DANNA D MATTHEW OSBORN		FACILITY TYPE:	830
ADDRESS:	14969 LOS GATOS ALMADEN ROAD		TELEPHONE:	(408) 626-9200
CITY:	LOS GATOS	STATE: CA	ZIP CODE:	95032
CAPACITY:	32	CENSUS: 0	DATE:	12/30/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Danna Matthew-Osborn		TIME COMPLETED:	01:00 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 Analyst (LPA) Mel Matos conducted a scheduled Tele-Pre-Licensing inspection via video conference call (FaceTime) with Danna Matthew-Osborn, Director. The Facility is applying for a change of ownership from sole proprietorship (Danna Matthew-Osborn) to Peppertree Schools, LLC. The Applicant Representative, Jeffrey Osborn, was not present during today’s Pre-Licensing inspection. The Applicant Representative is applying for a combination center in conjunction with the change of ownership (Infant #434415602 and Preschool #434415601) on the same premises. The existing Facility is currently in operation (Infant: #434408765 & Preschool: #434408764) on the same premises. A Fire Clearance was approved by San Jose Fire Department on 11/24/2020. The Infant Program will operate Monday through Friday from 6:30 AM to 6:00 PM, serving infant children ages 0-2 years of age. The Infant Program will be utilizing Rooms 1, 3 & 4 and the Preschool Program will be utilizing Room 5 (preschool) and Room 2 (preschool toddler option). The Facility was inspected inside and outside via video conference call (FaceTime). During today’s video conference call, the indoor/outdoor measurements were taken by Danna Matthew-Osborn, director. LPA observed the measuring process and provided direction over the video conference call. Indoor Activity Space: Room 1: (21.258 x 31.983 = 679.894) – (396.954 encumbered space) = 282.940 Room 3: (21.258 x 31.983 = 679.894) – (396.954 encumbered space) = 282.940 Room 4: (31.300 x 26.808 =839.090) + (9.916 x 5.583 = 55.361) = 894.451 (Total sq. ft.) – (Total Encumbered Space) = 894.451 - 48.879 = 845.572 TOTAL INDOOR ACTIVITY SPACE: 1,411.372 sq. ft. divided by 35 = 40 Infants

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2021

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 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: PEPPERTREE SCHOOLS RANCH HOUSE	FACILITY NUMBER: 434415602
	VISIT DATE: 12/30/2020

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
26
27
28
29
30
31
32

Danna states that the Infant center will not offer potty training. LPA observed a changing table that is within an arm's reach of a sink in each Room. LPA observed a trash can with a tight fitting lid for diaper disposal and solid waste containers with tight-fitting lids in each Room. LPA observed the cleaning supplies are kept on high shelves inaccessible to children. LPA observed functioning smoke/carbon monoxide detectors in each Room. First aid supplies, including touchless thermometer, are stored in each Room inaccessible to children. Danna states that the medications will be stored in Director's office.

Incidental Medical Services (IMS) policy was discussed. Danna was provided the information regarding ADA: toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: http://www.ada.gov/childqanda.htm. Danna states that the Facility plans to offer IMS services (inhaler & EpiPen) and an IMS plan is on file.

LPA observed refrigerator, microwave, and bottle warmers in each Room. Feeding chairs and other appropriate seating equipment will be used to seat infants during feeding. Danna understands that infants shall be held during feedings if they are unable to sit unassisted. Danna also understands that propped bottles are not permitted. Danna understands that the Needs and Service Plan needs to be updated at least once every 3 months or more often if necessary. Danna understands that baby walkers or any similar items are not permitted.

There are 3 tables, 24 chairs, 8 cribs, 32 cubbies, and 16 mats for the infant children. Infants that do not require cribs will nap on mats. LPA reminded Danna that each crib or mat shall be occupied by only one infant at a time and each infant's bedding shall be used for him/her only. Such bedding shall be replaced daily or when wet or soiled. All infant rooms are furnished with age appropriate supplies and toys. There are separate staff bathrooms not utilized by the children which an isolated child can be used if needed.

The Facility has 4 sinks (60) for children to use. The sinks for the infant children have hot water that is measured at less than 120 degrees F. Danna states that parents will provide formula, baby food (including snacks), and diapers. Drinking water is available indoors via sippie cups & water jugs/individual water cups. Disposable dishes and utensils will be provided.

Jeffrey Osborn, Applicant Representative, and Danna Matthew-Osborn, Director, have obtained Criminal Records Clearances and Child Abuse Index Checks. Danna Matthew-Osborn, director, has met the education and experience qualification requirements. Danna has valid CPR/First Aid certifications on file (exp: 03/2021) and completed the Preventative Health/Safety Training on December 5, 2021, which includes the Nutrition and Lead Safety component. Danna has proof of immunity against Measles and Pertussis and opt-out form for the influenza vaccine on file. Danna’s Mandated Reporter Training for Child Care Provider Certification expires 10/08/2021.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2021

LIC809 (FAS) - (06/04)

Page: 2 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: PEPPERTREE SCHOOLS RANCH HOUSE	FACILITY NUMBER: 434415602
	VISIT DATE: 12/30/2020

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
26
27
28
29
30
31
32

LPA reminded Danna of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the facility, and who come in contact with or provide care and supervision to children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12 month period, civil penalty amounts to $100.00 per person up to $3000.00 per person.

Outdoor Activity Space:

Front Playground: 72.000 x 59.833 = 4,307.976 minus 47.917 encumbered space = 4,260.059

Back Playground: 96.417 x 24.333 = 2,346.114

TOTAL OUTDOOR SPACE: 6,606.173 sq. ft. divided by 75 = 88 children

LPA observed that the playground areas are safe, secure, and surrounded by appropriate fencing. No bodies of water were observed. LPA observed the outdoor activity space is equipped with age-appropriate toys and equipment. Shade is provided by canopies, trees, and building overhangs. The areas around and under the play structures (Little Tykes) are cushioned with material (artificial grass with padding) that absorbs falls. Drinking water is available outdoors via sippie cups & water jugs/individual water cups.

LPA advised Danna that due to the current Covid-19 pandemic and "Shelter In Place" Order, the Evaluation Report will be emailed to her (email: danna.osborn@peppertreeschools.com) with "Read Receipt" notification. Danna understands that her reply to the email will serve as acknowledgement that the report was received.

LPA conducted an exit Interview and advised Danna that a license for 32 Infant children will be approved upon the receipt of the following:

1) Acknowledgement of "receipt" of today's report has been received by LPA Matos

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3