444417001-9-7-2021-07-CC-DMAC-C6MTKS-20210907144822

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444417001
Report Date: 09/07/2021
Date Signed: 09/07/2021 02:48:48 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:	SPROUTS SC		FACILITY NUMBER:	444417001
ADMINISTRATOR:	JORDAN BEMEL		FACILITY TYPE:	840
ADDRESS:	840 NORTH BRANCIFORTE AVENUE		TELEPHONE:	(831) 429-3898
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95062
CAPACITY:	30	CENSUS: 0	DATE:	09/07/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Jordan Bemel		TIME COMPLETED:	01:10 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 Analysts (LPAs), Marilou Monico and Dung Mac, conducted an announced pre-licensing inspection to the Facility today. LPAs met with Jordan Bemel, Applicant, and explained the nature of today's inspection. The Applicant has applied for a school age license in Room 27 on the campus of Santa Cruz City Schools District. The school age program will operate Monday thru Friday from 12:30 PM to 6 PM and from 9 AM to 6 PM during school breaks/holidays. A fire clearance approval for 30 school age children was received from the San Cruz Fire Department prior to today's inspection. The school age program is exempt from indoor and outdoor square footage requirements, sink/toilet ratios, isolation space, and fencing requirements since it is located at a functioning public schools site. A capacity letter (30 children in Room 27) from the Santa Cruz School District was received prior to today's visit. LPAs toured Room 27 as well as the playground areas and bathrooms during today's visit. LPAs observed 36 chairs and 6 tables. LPAs observed a trash can with tight fitting lid and adequate equipment, furniture, and supplies for children. The children’s bathrooms are located on the first floor of Monarch School Building and allow for individual privacy. Staff have designated bathrooms on the second floor of Monarch School Building. LPAs did not observe any fireplaces or wall heaters at the Facility. Room 27 has appropriate lighting and ventilation (central heating/air conditioning). First aid supplies are stored in Room 27 inaccessible to children. LPAs observed functioning smoke detector/carbon monoxide, fully charged fire extinguisher 2A10BC. Report Continued on Pages #2 & #3:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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: SPROUTS SC	FACILITY NUMBER: 444417001
	VISIT DATE: 09/07/2021

NARRATIVE

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The Facility will only provide snacks for the school age children. There is a food preparation area in the Room 27. Disposables dishes and utensils will be used to serve snack to the children. Drinking water is provided via a combination of water fountains and water dispensers both indoors/outdoors. Cleaning supplies will be stored in a locked cabinet under the sink in the classroom. Transportation will not be provided by the Facility.

The program will utilize the playground located next to the lunch area in front of Monarch School Building which has an age appropriate climbing structure with sufficient resilient materials. The school age program will use the playground after public schools hours. Shade is provided by an outdoor patio. There is adequate equipment and supplies for children outdoors. LPAs did not observe any bodies of water during today's visit.

LPAs discussed Senate Bill 792, AB 633, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years with Site Supervisor. Licensing forms, Title 22 regulations, can be obtained through the internet at ww.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com.

Beginning January 1, 2019 AB 2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

Incidental Medical Services (IMS) policy was discussed with the Applicant. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing 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. The Applicant states that he does not plan on administering medication to the day care children at this time.

Report continued on page #3:

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: SPROUTS SC	FACILITY NUMBER: 444417001
	VISIT DATE: 09/07/2021

NARRATIVE

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A review of staff records on September 7, 2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPAs reminded Jordan of the applicable $100 civil penalty per person per day, a minimum of $100.00 to a maximum of $3000.00 per person 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.

LPAs conducted an exit interview with Jordan and advised him that a school age license for 30 school age children will be approved upon completion of the following items:
1) Photos showing that Room 27 is fully set up
2) Photos of 30 cubbies placed in the classroom
3) Manager’s review and approval

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

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