434415739-1-19-2023-07-CC-SYIP-CN8UQT-20230119144737

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415739
Report Date: 01/19/2023
Date Signed: 01/19/2023 02:47:42 PM

Document Has Been Signed on 01/19/2023 02:47 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:	SJB - ANTONIO DEL BUONO CDC		FACILITY NUMBER:	434415739
ADMINISTRATOR:	PATRICIA KEITH		FACILITY TYPE:	850
ADDRESS:	245 FARRELL AVENUE		TELEPHONE:	(408) 414-2700
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	44	CENSUS: 23	DATE:	01/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Patricia Keith and Maria Velazquez		TIME COMPLETED:	12:50 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) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Site Director Patricia "Patty" Keith and Regional Manager, Maria Velazquez, and explained the reason for the inspection. Present during today's inspection were 23 children and at least six (6) staff. License, notification of parent's rights, and car seat law were observed to be posted. LPA reviewed the sign in/out sheet. The hours of operation are Monday through Friday 7AM to 6PM. LPA toured in the inside and outside of the facility with Site Director. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible. There are toys and equipment for children, which were age appropriate. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last disaster drill was conducted on 12/15/2022. Site Director stated that there are no weapons, such as firearms, stored on the premise. The outdoor area is fenced. Area around play structure have resilient material. Shaded rest area is provided through canopy. LPA reminded Director to ensure that anything that states to keep out of reach of children, such as paint, is inaccessible to children and to dump out any water that collects. There were no bodies of water observed during today's inspection. ------------------continues on 809 dated 01/19/2023 page 2-------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

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: SJB - ANTONIO DEL BUONO CDC	FACILITY NUMBER: 434415739
	VISIT DATE: 01/19/2023

NARRATIVE

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---------------continuation of 809 dated 01/19/2023 page 1-----------------------

Facility does provide meals and snacks to children. Menu was observed to be posted. Kitchen has hot and cold running water. LPA reminded Director to check best by dates on food and milk. Trash can for waste has tight-fitted lids.

Facility does not have any children who requires Incidental Medical Services (IMS). For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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

A copy of the facility roster was obtained. Six (6) children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records and physician's report.

Three (3) staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit and Mandated Reporter training. There is a least one staff with a valid CPR/1st Aid, which expires on 10/28/2023.

All adults present have cleared fingerprints. Site Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

No deficiencies were issued as a result of this inspection. Exit interview conducted and report was reviewed with the Site Director, Patricia Keith and Regional Manger, Maria. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023

LIC809 (FAS) - (06/04)

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