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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444414596
Report Date: 01/10/2024
Date Signed: 01/10/2024 12:59:14 PM


Document Has Been Signed on 01/10/2024 12:59 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:CAMPUS KIDS CONNECTION INFANT AND TODDLER CENTERFACILITY NUMBER:
444414596
ADMINISTRATOR:PAOLINA PEACOCKFACILITY TYPE:
830
ADDRESS:305 ALTURAS WAYTELEPHONE:
(831) 462-9822
CITY:SOQUELSTATE: CAZIP CODE:
95073
CAPACITY:28CENSUS: 14DATE:
01/10/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nidya JuarezTIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPAs) Jessica Bongardt and Anna Moralas met with Nidya Juarez, Program Director, for an unannounced Required - 3 Year inspection. LPAs toured the indoor and outdoor areas of the Facility with Nidya during today's inspection. LPAs 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), Menus, and Activity Schedule. Days and hours of operation are (days and times). The facility is licensed to serve a maximum of 28 Children 16 infants and 12 toddlers.

LPAs reviewed five children's and four staff files during today's inspection. Each child's file reviewed contains all required forms/documents, including Admission Agreement, Emergency Medical Consent (LIC 627), and Information and Emergency Information form (LIC 700). All staff files reviewed contain the required forms/documents, including transcripts/verification of experience/immunization records, and Health Screening Report (LIC 503). All files reviewed did have current Mandated Reporter Certificates on file. . Nidya 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. Last fire/disaster drill was completed on 12/22/2023.

LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA observed seven Infants and four staff and seven toddlers and two staff during today's inspection. Nidya understands the conditions, limitations, and capacity specifications of the Facility license. Nidya understands that children shall be always visually supervised. If a child comes to the facility who exhibit symptoms of illness including, but not limited to, fever or vomiting, they are not accepted into care. Any child who become ill during the day, shall be isolated in the office area.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510)-566-5850
LICENSING EVALUATOR NAME: Jessica BongardtTELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CAMPUS KIDS CONNECTION INFANT AND TODDLER CENTER
FACILITY NUMBER: 444414596
VISIT DATE: 01/10/2024
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The Program Director understands that children's personal rights should not be violated, including no unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature.

LPAs observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Nidya states that the Facility has ABA Janitorial who comes and cleans and employees understand that the Facility must be kept free of flies and other insects & rodents. LPAs observed that all furniture and equipment is in good condition and safe for the children. Drinking water is made available to the children by a filtered water system and each child has their own bottle labeled with their name on it and it is washed in the dishwasher every night for the child.

LPAs observed there is hot and cold running water, refrigerator, and microwave on the premises. The facility provides AM/PM snacks and lunch is brought from home for the toddlers the infant food is brought from home and is labeled with each child's name on it. The Facility has trash cans with tight fitting lids for solid waste in the classroom. Cleaning supplies are inaccessible to the children and stored in cabinets located in areas off limits to children. LPAs observed a complete first aid kit available in the facility.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPAs observed that the outdoor equipment is age appropriate and in good condition. Shade rest areas are provided by canopies. There is sufficient resilient materials on the outdoor playground area. LPAs did not observe any bodies of water. Nidya states that the Facility does not provide transportation for the children.

Program 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.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510)-566-5850
LICENSING EVALUATOR NAME: Jessica BongardtTELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CAMPUS KIDS CONNECTION INFANT AND TODDLER CENTER
FACILITY NUMBER: 444414596
VISIT DATE: 01/10/2024
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This facility does not provide Incidental Medical Services – IMS at this time. 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

LPAs discussed the safe sleep regulations with Program Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed the Program Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.



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
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510)-566-5850
LICENSING EVALUATOR NAME: Jessica BongardtTELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CAMPUS KIDS CONNECTION INFANT AND TODDLER CENTER
FACILITY NUMBER: 444414596
VISIT DATE: 01/10/2024
NARRATIVE
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LPAs provided the Program Director with website resources on managing food allergies at school and handling medical emergencies related to food allergies.
CDC Managing Food Allergies at School
https://www.cdc.gov/healthyschools/foodallergies/index.htm
American Academy of Pediatrics Healthy Children Medical Emergencies
https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/When-to-Call-Emergency-Medical-Services-EMS.aspx

Exit interview conducted and report was reviewed with Nidya, Program Director. Two deficiencies were cited and appeal rights were given.

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: Jessica BongardtTELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 01/10/2024 12:59 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: CAMPUS KIDS CONNECTION INFANT AND TODDLER CENTER
FACILITY NUMBER: 444414596

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.2(b)(2)
Infant Needs and Services Plan
(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review, and interviews the licensee did not comply with the section cited above child 4 and child 5 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/24/2024
Plan of Correction
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Program Director will send by email a copy of child 4 and child 5 LIC 9227 to LPA Jessica Bongardt on or before POC due date
Type B
Section Cited
CCR
101429(a)(2)(C)(3)
Responsibility for Providing Care and Supervision for Infants
(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: (3) Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, ecord review, the Program Director did not comply with the section cited above in four out of the five records that were reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/17/2024
Plan of Correction
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Program Director will get the 15-minute sleep logs to LPA Jessica Bongardt by email on or before the POC due date
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: Jessica BongardtTELEPHONE: 408-834-2558
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2024
LIC809 (FAS) - (06/04)
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