434416176-6-26-2019-07-CC-MMOO-BDHRDC-20190626125542

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416176
Report Date: 06/26/2019
Date Signed: 06/26/2019 12:55:47 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:	SJB - JAMES LICK CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	434416176
ADMINISTRATOR:	YULIANA NIKITTIN		FACILITY TYPE:	830
ADDRESS:	57 NORTH WHITE ROAD		TELEPHONE:	(408) 928-5221
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95127
CAPACITY:	12	CENSUS: 0	DATE:	06/26/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Kelly Mercurio & Rebecca Larsen		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 (LPAs), Marilou Monico and Stephanie Collins, met with Applicant Representative, Kelly Mercurio and Site Director, Rebecca Larsen, for a prelicensing inspection. LPAs toured the facility both inside and out as well as measured the space available for the children. Indoor measurements are as follows: INFANT ROOM: 35.000 x 31.333 = 471.762 minus 103.330 (encumbered space) = 368.432 *TOTAL INFANT INDOOR SPACE: 368.432 sq. ft. divided by 35 = 10 children* There is 1 sink (15) available for the children in the infant program. There are 6 cribs, 5 cots, 14 cubbies, 6 chairs, and 1 table. Only cold is available in the children's sink. There are two staff bathrooms located next to the Infant Room. The sick child will use one of the staff bathrooms if needed and will be accompanied by a staff member. The sick child will be isolated in the Director's Office and isolation equipment will be provided. First Aid supplies are available in the room inaccessible to the children. There is a diaper changing table within arm's reach of a sink in the infant room. The center will be administering medication and medication lock box is stored in the upper cabinet in the classroom. The center will be providing breakfast, lunch, and afternoon snacks for those children who are eating solid food. There is a kitchen located in the classroom for food preparation. The kitchen is equipped with refrigerator, oven, stove, microwave, dishwasher, and a sink with hot and cold running water. Disposable dishes and utensils will be available for the children. Sanitation is by the dishwasher. LPAs observed trash cans with tight-fitting lids in the room for the disposal of solid waste. Cleaning products, sharp, objects, and other similar items are stored in the upper cabinet in the classroom. LPAs observed at least one functioning carbon monoxide detector at the facility. Site Director states there are no weapons on the premises. Drinking water indoor is via sippy cups and bottles. (REPORT CONTINUED ON THE FOLLOWING PAGES (PAGES #2 - REPORT DATED 06/26/19):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

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: SJB - JAMES LICK CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434416176
	VISIT DATE: 06/26/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 06/26/19):

TODDLER OPTION OUTDOOR MEASUREMENTS
TODDLER YARD: 1/2 (43.250)(30.000) = 648.75
43.250 x 26.583 = 1,149.714
1,798.464 minus 17.920 = 1,780.544
TOTAL TODDLER OPTION OUTDOOR SPACE: 1,780.544 sq ft divided by 75 = 23 children

The toddler option and the children from the infant program will be sharing the Toddler Yard at different times and will not commingle at any time. Shade in the toddler yard is by canopy and patio. The yard is surrounded with appropriate fencing and the outdoor surfaces are safe. Drinking water outdoor is via individual sippy cups and bottles. The center will not provide transportation for the children. There is a working telephone at the facility which is (408) 928-5221.

Facility will be providing Incidental Medical Services (IMS) and Plan of Operation will be submitted to Licensing.

LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years. AB 633 was discussed with Site Director. Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com. LPAs provided Site Director with lead safety information sheets and advised her to provide copies to parents.

A review of staff records during today's inspection indicates that not all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemption. LPA advised Site 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.

A license for 10 children in the infant program will be approved pending the receipt of the following:
1) Approved fire clearance
2) Proof of Operations/Record Keeping Orientation and 3 semester Infant/Toddler Class for Site Director.
3) Fingerprint association of all staff who will be working at this site.
4) Pediatric CPR/First Aid of at least one staff member who will be working at the site.
5) Copy of IMS Plan of Operation

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2019

LIC809 (FAS) - (06/04)

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