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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444404901
Report Date: 08/07/2019
Date Signed: 08/07/2019 10:49:20 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:CIRCLE OF FRIENDSFACILITY NUMBER:
444404901
ADMINISTRATOR:STACEY BOTKINFACILITY TYPE:
850
ADDRESS:111 NORTH NAVARRA DRIVETELEPHONE:
(831) 461-1366
CITY:SCOTTS VALLEYSTATE: CAZIP CODE:
95066
CAPACITY:39CENSUS: 27DATE:
08/07/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Stacey BotkinTIME COMPLETED:
11:05 AM
NARRATIVE
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Unannounced random visit made by Analyst Mahvash Behbood. Met Stacy Botkin, Licensee, present also were 26 children and 7 staff (5 teachers and 2 teachers aid). Operation hours is M-F from 7 AM to 6 PM. Indoor and outdoor of the facility was toured.
License, Personal Rights, Car Seat Poster & Parent's Rights are all posted. LPA reviewed samples of children's file and sign in and out sheets during today's visit. LPA observed that all children were properly signed in and out (legal signature & time of day) by a parent or authorized representative. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and a copy of the admission agreement. Several staff have current CPR and First Aid certifications and proof of immunization on file . Staff files have copies of their educational background. .
Teacher/children ratio was met during the visit.
Furniture & equipment appear in good condition. Floors appear clean. Children's bathrooms are in operating condition. There are Medications at the Center stored inaccessible to children ad in their original containers accompanied by parent's and physician's permission/direction in addition to the mediation log.
Playground has climbing structures, , sand boxes, etc. Wood chip are used for cushioning material.
Drinking water inside the classrooms via filtered water pitcher and in the playground are provided via water fountains.
Center provides snacks only. Kitchen appears clean. All food is covered & there is a trash can with a tight-fitting cover. children were visually supervised.
Stacy states she provides IMS for epi-pen and inhaler only when there is a need. She has submitted the IMS- PO
Effect of lead exposure poster was provided to licensee and for their information and to share with children. Discussed also was safe sleep.
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: 08/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CIRCLE OF FRIENDS
FACILITY NUMBER: 444404901
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2019
Section Cited
CCR
101227(a)(6)
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Food Service. Menus shall be posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request.
The menu posted was old. with no serving size. This is potentially dangerous to health and safety of children,

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A menu was made and posted during the visit. Cleared during visit.
Type B
08/23/2019
Section Cited
CCR
101238.2(e)
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Building and Grounds- As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls. Tan barks on under the play structures are low and compacted. This is potentially dangerous to health and safety of children.
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Licensee to send a proof of correction by due date.
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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: 08/07/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2019
LIC809 (FAS) - (06/04)
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