444412004-9-27-2019-07-CC-ZHAM-BGF2AU-20190927171406

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444412004
Report Date: 09/27/2019
Date Signed: 09/27/2019 05:14:31 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:	CAMPUS KIDS CONNECTION MOUNTAIN		FACILITY NUMBER:	444412004
ADMINISTRATOR:	BRITTANY WATERMAN		FACILITY TYPE:	840
ADDRESS:	3042 OLD SAN JOSE ROAD		TELEPHONE:	(831) 475-3274
CITY:	SOQUEL	STATE: CA	ZIP CODE:	95073
CAPACITY:	60	CENSUS:	DATE:	09/27/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:50 PM
MET WITH:	Brittany Waterman Christian		TIME COMPLETED:	05:45 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	Licensing Program Analyst (LPA) Zaid Hakim conducted an Unannounced Annual Random at the facility today. Upon arrival, LPA observed 23 school age children and at least 4 staff engaging in daily activities and met Ms. Brittany Waterman Christian, Program Director. The Acting Site Director was engaged with the group during the inspection and the Program Director facilitated the inspection. The program operates an an active elementary school campus and is licensed to serve 60 school age children ages Kindergarten through 6th grade in the portable classroom #18A and #18B. Days and hours of operation are Monday through Friday 12:30pm to 6:00pm. 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), Food Menus, and Activity Schedules. LPA reviewed a random sample of children's and staff files during today's visit. Each child's file reviewed contains the Emergency Identification Information form (LIC 700) and the Notification of Parent's Rights. All staff files reviewed contain the required transcripts/verification of experience, required immunization records, and required training. At least one staff on site at the time of the inspection maintains valid CPR/ First Aid certification with an expiration month of 10/2020. The Director s 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). The Director understands the conditions, limitations, and capacity specifications of the facility license. The Director understands that children shall be visually supervised at all times. LPA advised that due to the amount of outdoor space available to the children, staff supervision plans should be organized and in place. The facility is aware of the required sign in and sign out procedures for school age children who arrive at the facility on their own. The Director stated that all school age children are picked up by their respective parent(s)/guardian(s). LPA observed at the time of the inspection that a sign in/ sign out sheet is used and is updated throughout the day, with full legal signatures. The Director stated that children are observed for illnesses and general well-being upon arrival. Kindergarten children arrive to the program by staff escort whereas older age groups walk to the program after dismissal independently. LPA observed that program classrooms are in close proximity to the classrooms on campus. LPA observed that all children were directly supervised at the time of the inspection. 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 reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, 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 violations within a 12 month period. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 09/27/2018):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid Hakim	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019

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: CAMPUS KIDS CONNECTION MOUNTAIN	FACILITY NUMBER: 444412004
	VISIT DATE: 09/27/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 09/27/2018):

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

http://www.cdss.ca.gov/inforesources/Child-Care-Licensing

The Director stated that all staff have completed the required Mandated Reporter Training and understands training requirements for training renewal. https://mandatedreporterca.com/

LPA observed that all staff files reviewed maintained training certificates and LPA and the Director also discussed applicable updates to this training regarding length and material and the renewal period of every 2 years. LPA provided additional written information on Mandated Reporter Training, Active Shooter Information, Effects of Lead Exposure, and Safe Sleep for Infants.

A Notice of Site Visit has been issued and must remain posted for 30 consecutive days.

No Deficiencies have been cited as a result of today's inspection. Exit interview conducted with Ms. Brittany Waterman Christian.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid Hakim	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019

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: CAMPUS KIDS CONNECTION MOUNTAIN	FACILITY NUMBER: 444412004
	VISIT DATE: 09/27/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 09/27/2018):

LPA observed that all activity areas are clean and safe for all children and staff. Drinking water is readily available for the children in the classroom and in the outdoor playground area via drinking fountains and personal water bottles. Meals and snacks are provided to children and stored in the classroom. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary, and operable. The Director stated that there are no weapons or firearms on the premises. Cleaning supplies are inaccessible to the children and stored in locked cabinets. Any medications at the facility are securely stored, locked, and in an inaccessible location accompanied with the required documentation. Emergency disaster drills are done as required with Fire and Earthquake Drills last conducted on 09/2019. The last fire inspection conducted by the local fire authority in which all fire safety items were maintained was in 06/2020.

LPA observed that the facility is equipped with functional smoke detectors, carbon monoxide detectors, complete First Aid Kits, and Fire Extinguishers. The children in care are designated to use restrooms located on the main school campus. LPA and the Director discussed restroom supervision protocols.

LPA observed all furnishings and equipment to be age appropriate, in good condition, and in adequate supply for the licensed capacity. Children have cubbies designated for storage or personal items. The playground area used by the program are three play structures, a black top area, and a grass area. LPA and the Director discussed supervision requirements during outdoor play time. LPA observed that the outdoor equipment is age appropriate and in good condition and there is sufficient resilient materials in the outdoor playground area. LPA did not observe any bodies of water. LPA and the Site Director discussed AB 633, healthy beverages in child care, forms of discipline, and emergency lock-down procedures. Facility staff use walkie-talkies to communicate when providing supervision to the children and school intercom systems can be heard from the classroom.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 09/27/2018):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid Hakim	TELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2019

LIC809 (FAS) - (06/04)

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