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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416695
Report Date: 12/15/2021
Date Signed: 12/17/2021 11:09:14 AM

Document Has Been Signed on 12/17/2021 11:09 AM - 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:LITTLE OAK NURSERYFACILITY NUMBER:
434416695
ADMINISTRATOR:JENNIFER POTMESILFACILITY TYPE:
830
ADDRESS:1921 CLARINDA WAYTELEPHONE:
(408) 396-1252
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 30TOTAL ENROLLED CHILDREN: 17CENSUS: 9DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Jennifer PotmesilTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year inspection today and met with Director, Jennifer Potmesil.

LPA observed the required posted materials which includes the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule are posted prominently. The Center's operation days and times are Monday through Friday from 08:00AM to 04:30PM.

LPA toured the facility with the Director. The infant program uses Room numbers 8, 9, and 32.
Infant rooms have trash cans and solid waste containers with tight fitting lids for disposals. Fire extinguishers and smoke/carbon monoxide detectors were observed in each rooms. LPA observed refrigerators, microwaves and bottle warmers in each room. Highchairs and cribs were observed to be in good condition. Rooms are furnished with age appropriate toys. Bathroom was observed to be clean and in good condition. There are cubbies and hooks for children to store their belongings. Disinfectants, cleaning solutions and other chemical items and sharp objects are stored and inaccessible to children. Per Director, they do not have poisons, weapons and ammunition on the premises.

Director stated that parents provide formulas, baby food, and diapers. Children's formulas and baby food are properly stored in the refrigerator. Allergy medications are stored and secured in the classrooms and all other medications are stored in the administration office.

Playground/outdoor area is surrounded by appropriate fencing. No bodies of water were observed. Outdoor activity space is equipped with age-appropriate toys and equipment.

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Due to time constraints, the annual inspection will be continued on a later date.

NOTICE OF SITE VISIT WAS ISSUED. DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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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