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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440710237
Report Date: 09/11/2019
Date Signed: 09/11/2019 02:46:53 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:DE LA VEAGA CKC INC.FACILITY NUMBER:
440710237
ADMINISTRATOR:PAYA VANGFACILITY TYPE:
840
ADDRESS:1145 MORRISSEY BOULEVARDTELEPHONE:
(831) 426-7402
CITY:SANTA CRUZSTATE: CAZIP CODE:
95065
CAPACITY:100CENSUS: 72DATE:
09/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Gretchen GriffinTIME COMPLETED:
03:05 PM
NARRATIVE
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Licensing Program Analyst (LPA), Behbood, conducted an unannounced random visit to the Facility today. LPA met with Gretchen Griffin, Program Director explained the nature of today's visit. Present also were 9 staff and 72 children. LPA toured Room 34 and 35, outdoor area and boys and girls bathroom.
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), Child Car Seat Law (PUB 269), Menus (includes current and following week), and Activity Schedule.
A review of staff records indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
LPA reviewed sample children's file and sign in and out sheets during today's visit. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and a copy of the admission agreement. LPA observed all children were properly signed in and out. Staff who open and close the facility have current CPR and First Aid certifications. Staff files have copies of their educational background and proof of immunization on file.
Furniture & equipment appear in good condition. Floors appear clean. Children's bathrooms are in operating condition.
Center refrigerator appears clean & all food is covered. Trash can for food waste has a tight fitting cover. Menu is posted.
Playground has climbing structures, Tan bark is used for cushioning material.
Drinking water inside and in the playground provided via water fountain.
Please see next page for citations under Title 22.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
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: DE LA VEAGA CKC INC.
FACILITY NUMBER: 440710237
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2019
Section Cited

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Health and Safety - Mandated Child Abuse Reporter Training- At least 4 staff has not completed the mandated child abuse reporter training. This is potentially hazardous to health and safety of children.
Type B
09/30/2019
Section Cited

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Building and Grounds - The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. Girls bathroom was dirty (feces on the wall), This is potentially hazardous to health and safety of children.

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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2019
LIC809 (FAS) - (06/04)
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