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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444413865
Report Date: 02/09/2023
Date Signed: 02/09/2023 02:46:06 PM


Document Has Been Signed on 02/09/2023 02:46 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:LITTLE ACORNS MONTESSORIFACILITY NUMBER:
444413865
ADMINISTRATOR:HOLLIS MEYER DELANCEYFACILITY TYPE:
830
ADDRESS:1215 CHANTICLEER AVETELEPHONE:
(831) 464-9330
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY:8CENSUS: 8DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Melinda GillenTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Joe Macias, and Farida Raja conducted an unannounced Required - 1 Year Inspection (care tool). The purpose of today’s visit is to ensure the facility is in compliance with Title 22 California Code of Regulations. LPAs met with the Owner/ Director Melinda Gillen, and explained the nature of today's visit. The facility also has a preschool license #444413867 on site. LPA toured the Facility both inside and outside during todays visit. 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), and Activity Schedule. The hours of operation are Monday - Friday, 7:30am - 5:30pm.

LPA reviewed eight children's and two staff files during today's visit. Each child's file reviewed contains the Information and Emergency Information form (LIC 700), immunization records, LIC 9227, physicians report, personal rights, and parents rights, as well as Needs & Services Plans. Needs & Services Plans also include individual feeding plans for each child and are updated at least once every three months or sooner if needed. The Site Directors file contain the required transcripts/verification of experience. Director and all staff have current CPR and First Aid certifications on file. The Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times in each licensed program (infant/ preschool) or present during off-site activities (field trips). All staff's Mandated Reporter training have expired.

Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that infants shall be visually supervised at all times. LPAs observed that all rooms are in order. Drinking water is readily available for the children in each room and in the outdoor playground area via water dispensers, and water bottles. LPAs observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Director states that there are no weapons or firearms on the premises.

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023
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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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: LITTLE ACORNS MONTESSORI
FACILITY NUMBER: 444413865
VISIT DATE: 02/09/2023
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The LPAs observed all furniture and equipment is in good condition and safe for the children. The infant changing table has raised sides that are at least 3 inches in height. The infant changing table(s) has a vinyl changing pad that is at least 1 inch think and in good condition. Napping equipment is appropriate. The playground area utilized by children is surrounded by appropriate fencing. The infant playground/ outdoor space is separate from the preschool outdoor space. LPA observed that the outdoor equipment is age appropriate. LPA did not observe any bodies of water.

LPAs also went over safe sleep for infants.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. Cleaning supplies are securely stored and inaccessible to the children. LPA observed a fully charged 2A10BC fire extinguisher, and working smoke/carbon monoxide detectors. Director states that the Facility does not administer medications at this time.


The Owner/ Director Melinda Gillen was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
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: LITTLE ACORNS MONTESSORI
FACILITY NUMBER: 444413865
VISIT DATE: 02/09/2023
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To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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 Deficiency cited, exit interview conducted and report was reviewed with the Owner/ Director Melinda Gillen .

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/09/2023 02:46 PM - It Cannot Be Edited

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: LITTLE ACORNS MONTESSORI
FACILITY NUMBER: 444413865

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2023

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
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Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. All staff's Mandated Reporter training have expired.
POC Due Date: 03/09/2023
Plan of Correction
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All staff will complete the Mandated Reporter training, and submit proof of completion by the POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023
LIC809 (FAS) - (06/04)
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