444400415-2-19-2020-07-CC-SYIP-BLXQFK-20200219110805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444400415
Report Date: 02/19/2020
Date Signed: 02/19/2020 11:08:12 AM

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:	COMMUNITY BRIDGES SYCAMORE STREET CHILD DEV CENTER		FACILITY NUMBER:	444400415
ADMINISTRATOR:	ARASELE ROCHA		FACILITY TYPE:	850
ADDRESS:	121 SYCAMORE STREET		TELEPHONE:	(831) 454-9920
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95060
CAPACITY:	32	CENSUS: 23	DATE:	02/19/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:22 AM
MET WITH:	Arasele Rocha and Lisa Hindman Holbert		TIME COMPLETED:	11:15 AM

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 annual random inspection. LPA met with Site Supervisor/Program Coordinator Arasele Rocha and explained the reason for the inspection. Program Director Lisa Hindman Holbert arrived shortly after. Upon arrival of inspection were 23 children and at least 4 staff. The teacher child ratio was observed to be in compliance during today's inspection. License, Emergency Disaster Plan, and Notification of Parents were posted. LPA reviewed sign in/out sheet, which contains full signature. LPA toured in the inside and outside of the facility with Ms. Arasele. Disinfectant, cleaning supplies, and other items that are dangerous to children were observed to stored inaccessible. Furniture and equipment, such as chairs and tables, were observed to be age appropriate. LPA observed that cabinets in the Room 1 and outside where hinges were starting to get loose. LPA discussed with Ms. Arasele about how can become a safety hazard. Ms. Arasele stated that they will be having a parent work day and will have it fixed. LPA observed that there is sufficient amount of toys for children in care. Bathroom for children were observed to be in functioning condition. Storage containers for waste have tight fitted lids. There is fully charged fire extinguisher, smoke detector, and carbon monoxide. The last fire/disaster drill was conducted on 01/2020. Ms. Arasele stated that there are no weapons, such as firearms, stored on the premise. The outdoor activity area is fenced. Play structure outside was observed to in good condition. Areas around play structure have resilient material. LPA discussed with Ms. Arasele about plans for obtaining more tan bark and having staff even out tan bark before children go outside. LPA also discussed with Ms. Arasele about checking that all toys outside are in good condition. Shaded rest area is provided through building overhang and canopy. There were no bodies of water observed during today's inspection. -----------------------continues on 809 dated 02/19/2020 page 2------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

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: COMMUNITY BRIDGES SYCAMORE STREET CHILD DEV CENTER	FACILITY NUMBER: 444400415
	VISIT DATE: 02/19/2020

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----------------------continuation of 809 dated 02/19/2020 page 1----------------------------------
Facility does provide meals and snacks to the children in care. Kitchen used to prepare snacks was observed to clean. Menu was observed to be posted. Drinking water is provided through water jugs and cups.

Ms. Arasele stated that they currently do not have any children in care who requires Incidental Medical Services (IMS). 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.

10 children's files were reviewed during today's inspection. The records reviewed include but not limited to admission agreement and Physician's Report. LPA reminded Ms. Arasele to check that all forms are completed, such as Screening for TB risk factor on Physician's Report.

4 staff files were also reviewed during today's inspection. The records reviewed include but not limited education credit and Mandated Reporter Training. All staff have a valid CPR/1st Aid. Site Supervisor's CPR/1st Aid expires on 08/2021. LPA remined Site Supervisor that Mandated Reporter Training requires renewal every 2 years and to keep certificate in file.

All staff present have cleared criminal record and child abuse index clearance. LPA reminded Ms. Arasele of the applicable civil penalties for those adults who have not received fingerprint clearance, 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.

Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online Licensing Forms, Adoption of new Laws, etc.

In the areas evaluated during today's inspection, no deficiencies have been cited. An exit interview was conducted where this report was discussed with Ms. Arasele Rocha and Ms. Lisa Hindman Holbert. A notice of site visit has been issued and must be posted for 30 consecutive days.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

LIC809 (FAS) - (06/04)

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