444403616-9-28-2023-07-CC-FRAA-CW4V8H-20230928161246

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444403616
Report Date: 09/27/2023
Date Signed: 09/28/2023 04:12:53 PM

Document Has Been Signed on 09/28/2023 04:12 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ROSE BLOSSOM NURSERY SCHOOL		FACILITY NUMBER:	444403616
ADMINISTRATOR:	ROSE, SHARON		FACILITY TYPE:	850
ADDRESS:	6401 FREEDOM BOULEVARD		TELEPHONE:	(831) 662-8458
CITY:	APTOS	STATE: CA	ZIP CODE:	95003
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 22	CENSUS: 12	DATE:	09/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Sharon Rose		TIME COMPLETED:	12:45 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	On 09/27/2023 at 9:10 am, Licensing Program Analyst (LPA), Farida Raja, met with Director, Sharon Rose, for an unannounced annual inspection at the preschool program. The facility is licensed to serve children ages 2 years 6 months to entry into first grade. LPA observed the required posted materials near the front entrance to the facility. LPA observed sign in and out log outside the facility entrance with full parent signatures. Days and hours of operation are Monday through Friday, 8:00 am to 2:00 pm. LPA observed 12 children and 3 teachers including Director during today's inspection. Facility is in compliance with teacher to children ratio requirement. LPA and Director toured the indoor and outdoor areas of the facility. The classrooms, children's restroom and staff restroom were inspected. Children were engaged in various activities under visual supervision of teachers. Facility has central heating and a cooling setting on the thermostat that maintains a temperature that is comfortable for children. Director states that there are no weapons on the premises. There is a working telephone at the facility (831-662-8458). LPA observed disinfectants and cleaning products were stored inaccessible to the children in high cabinets in the bathroom. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Floors were clean and free from tripping hazards. Since children do not nap at the facility LPA did not observe napping equipment. LPA observed solid waste containers with tight-fitting lids in the rooms. Restroom and sink for children were observed to be safe, sanitary, and in working condition. Staff has one separate bathroom that can be utilized by sick children if needed. The facility has a built-in smoke detector/ fire system and LPA observed a 3A40BC fire extinguisher during today's inspection. Log shows that the last Fire Drill was conducted on 09/21/2023 which is compliant with the six-month requirement for facilities. Director will submit an updated Emergency Disaster Plan to LPA by 10/11/2023. Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles, water pitchers and disposable cups. Water lead testing was completed for the Continued on Page 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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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Document Has Been Signed on 09/28/2023 04:12 PM - It Cannot Be Edited

Created By: Farida Raja On 09/27/2023 at 11:46 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: ROSE BLOSSOM NURSERY SCHOOL	FACILITY NUMBER: 444403616
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2023

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
1 2 3 4	Based on record review and observation, the licensee did not comply with the section cited above for three (3) staff which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/11/2023
	Plan of Correction
1 2 3 4	Director and staff will complete Mandated Reporter Training and submit certificate of completion to LPA by plan of correction date of 10/11/2023.

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
1 2 3 4	Based on record review and interview, the licensee did not comply with the section cited above for staff S2 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/11/2023
	Plan of Correction
1 2 3 4	Director will submit proof of immunization for staff, S2, to LPA by plan of correction date of 10/11/2023.

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:

Farida Raja

LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ROSE BLOSSOM NURSERY SCHOOL	FACILITY NUMBER: 444403616
	VISIT DATE: 09/27/2023

NARRATIVE

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facility on 10/29/2022 and no Action Level Exceedances were reported. Director stated that she will submit LIC 9275, LIC 9276, facility sketch (LIC 999) indicating drinking water and food preparation outlets and water lead test report to LPA. 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 child care 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). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Children bring snack and lunch from home, so there is no food preparation at the preschool. Foods and beverages were stored safely to prevent contamination and spoilage. Food storage areas were observed to be sanitary.

Outdoor playground and play equipment was inspected and observed to be fenced in and free of hazards. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (tankbark) to absorb falls. Areas around and under swings, high climbing equipment and slides were cushioned with resilient material that absorbs falls. Shaded rest area is provided by building awning, trees and umbrellas. There were no bodies of water observed.

Children's roster was reviewed, and a copy was provided to the LPA. LPA reviewed nine (9) files during today's inspection. Each child's file reviewed contained the required forms.

LPA reviewed three (3) staff files. All staff files reviewed contain the required transcripts/verification of experience. At least one staff member on site has a current CPR and First Aid certification on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). Staff (S2) did not have immunization's in file against pertussis, measles and influenza/statement declining influenza. LPA did not observe Mandated Reporter Training Certificate for three staff. Director understands the training is mandatory to all staff in contact with children and requires renewal every two years. LPA referred director to the training website: www.mandatedreporterca.com for additional information on the online training.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ROSE BLOSSOM NURSERY SCHOOL	FACILITY NUMBER: 444403616
	VISIT DATE: 09/27/2023

NARRATIVE

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Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Director stated that facility does not handle medications and currently has no children in care who require Incidental Medical Services (IMS). Isolation of sick child was discussed, and Director stated that sick children will be isolated in the play room and isolation equipment will be provided. A staff restroom which is off limits to other children is used if necessary. Child is always under visual supervision while in care of the facility. Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Facility does not provide transportation to children, but Director understands that children cannot be left alone, unattended in parked vehicles. Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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

Type B deficiencies were cited today on the attached LIC 809D page. Appeal rights were printed and provided to Director. LPA reminded director that failure to correct deficiencies by Plan of Correction Due Date may result in penalties of $100 per day per violation. Exit interview was conducted with Director, Sharon Rose.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

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