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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416683
Report Date: 01/30/2024
Date Signed: 01/30/2024 12:24:51 PM

Document Has Been Signed on 01/30/2024 12:24 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ONE WORLDFACILITY NUMBER:
434416683
ADMINISTRATOR:ANNA SIFUENTESFACILITY TYPE:
850
ADDRESS:8387 WREN AVENUETELEPHONE:
(408) 842-4148
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 26DATE:
01/30/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Anna SifuentesTIME COMPLETED:
12:35 PM
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On 1/30/2024, at 9:15 AM, Licensing Program Analysts (LPAs) Doni Fici and Cortney Nelson arrived unannounced to conduct a Required 3-Year inspection and was greeted by Anna Sifuentes, Licensee. LPA toured the indoor and outdoor areas of the Facility with Anna during today's inspection.

LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Menus, and Activity Schedule. Days and hours of operation are Monday through Friday 8:00AM to 5:00PM.

LPAs reviewed four (4) staff, and five (5) children's files during today's inspection. Each child's file reviewed contains all required forms/documents, including Admission Agreement, Emergency Medical Consent (LIC 627), and Information and Emergency Information form (LIC 700). All staff files reviewed contain the required forms/documents, including current CPR and First Aid certifications on file. Licensee understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during any off-site activities. Last fire/disaster drill was completed on 12/20/2023.

LPAs observed that the teacher/child ratio was in compliance during today's inspection. LPAs observed 4 Staff and 26 Children during today's inspection. Anna understands the conditions, limitations, and capacity specifications of the Facility license. She understands that children shall be always visually supervised. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted into care. Any child(ren) who become ill during the day, shall be isolated near the bathroom in the hall.


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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ONE WORLD
FACILITY NUMBER: 434416683
VISIT DATE: 01/30/2024
NARRATIVE
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LPAs observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Licensee understands that the facility must be kept free of flies and other insects & rodents. LPAs observed that furniture and equipment is in good condition and safe for the children. Children have their own water bottles labeled with their name on it, when playing outdoors there are water cooler stations for the children along with they have their water bottles.

LPA observed running water, refrigerator and microwave on the premises. AM/PM snacks are provided from the facility. The Facility has trash cans with tight fitting lids for solid waste in the classroom. Cleaning supplies are inaccessible to the children and stored in cabinets located in areas off limits to children. LPAs observed a complete first aid kit available in the facility.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade rest areas are provided by trees and canopies. There are sufficient resilient materials on the outdoor playground area. LPAs did not observe any bodies of water. Licensee states that the Facility does not provide transportation for preschool children.

Licensee 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.

This facility does provide Incidental Medical Services (IMS) at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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. Licensee does not have any children currently receiving Incidental Medical Services (IMS).

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
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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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: ONE WORLD
FACILITY NUMBER: 434416683
VISIT DATE: 01/30/2024
NARRATIVE
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Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). The facility has indicated that they do not use any facets for drinking or food preparation.

Licensee understands that children's personal rights should not be violated, including no unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

LPA provided Licensee with website resources on managing food allergies at school and handling medical emergencies related to food allergies.

CDC Managing Food Allergies at School

https://www.cdc.gov/healthyschools/foodallergies/index.htm

American Academy of Pediatrics Healthy Children Medical Emergencies

https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/When-to-Call-Emergency-Medical-Services-EMS.aspx

A Notice of Site Visit was given and must remain posted for 30 days.



Deficiencies were issued during today's visit. Exit interview conducted with Licensee, and a copy of this report reviewed and provided.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 01/30/2024 12:24 PM - It Cannot Be Edited


Created By: Liridon Fici On 01/30/2024 at 11:48 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ONE WORLD
FACILITY NUMBER: 434416683

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as 1 out of 4 staff members (S4) did not complete mandated reporting training which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/06/2024
Plan of Correction
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Licensee will have S4 complete her mandated reporting training by 2/6/2024 and to submit to CCL by POC due date.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as 2 out of 4 staff members (S2, and S4) do not have their Immunization records on file for the departments review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/06/2024
Plan of Correction
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Licensee will submit Immunization records for S2 and S4 to CCL by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Liridon Fici
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 01/30/2024 12:24 PM - It Cannot Be Edited


Created By: Liridon Fici On 01/30/2024 at 11:48 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ONE WORLD
FACILITY NUMBER: 434416683

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on observation and record review, the licensee did not comply with the section cited above as 2 out of 4 staff members (S1 and S4) do not have their Health screening (Lic503) on file for the departments review which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/06/2024
Plan of Correction
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Licensee will submit a completed health screening (Lic503) for S1 and S4, including proof of negative TB to CCL by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Liridon Fici
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2024


LIC809 (FAS) - (06/04)
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