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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274410785
Report Date: 10/03/2024
Date Signed: 10/03/2024 02:08:16 PM


Document Has Been Signed on 10/03/2024 02:08 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:M.A.O.F. GREENFIELD EARLY LEARNING CENTERFACILITY NUMBER:
274410785
ADMINISTRATOR:JENNIFER MANCERAFACILITY TYPE:
850
ADDRESS:131 13TH STTELEPHONE:
(831) 674-5810
CITY:GREENFIELDSTATE: CAZIP CODE:
93927
CAPACITY:24CENSUS: 14DATE:
10/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Juana Lola GarciaTIME COMPLETED:
02:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Martha Jimenez-Villanueva and Licensing Program Manager (LPM) Belinda DeVall met with Juana Lola Garcia Site Director, for an unannounced case management inspection in response to a self reported Unusual Incident reported to the Department. During the visit LPA observed 14 children were in care in the playground area with 5 Staff. LPA conducted interviews and record reviews.

An incident occurred on August 27, 2024 at approximately 10:50am, where a child had ingested soap water during outdoor water activity play. There were two staff members in the outdoor area observing 16 children. During the water activity, S1 turned from the water table to address two other children who were fighting. S2 was at the water table and turned their direction to another child when C1 ingested water from the water bucket. C1 has a known history of placing items in their mouth. Staff did not observe C1 ingesting the soap water. C1 began to show symptoms of vomiting and not behaving like their normal self when staff called 911 and C1 was checked by the paramedics and told to
monitor the child as the child was fine.

Based on the available evidence, it is concluded that a child, with known behavior of placing items in their mouth, was not under supervision throughout the outdoor water activity where the child was able to ingest soap water without staff noticing or intervening and the paramedics had to be called as C1 was experiencing symptoms that needed emergency medical treatment.

This presented an immediate health & safety risk and thus a Type A deficiency is cited on the attached page (809-D). Exit interview conducted and report was reviewed with the Site Director, Juana Lola Garcia, and copy of appeal rights was provided. A Notice of Site Visit was given and must remain posted for 30 days.
Also, LPA Martha Jimenez-Villanueva informed the facility representative Juana Lola Garcia to provide a copy of this licensing report dated 10/03/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISOR'S NAME: Belinda DevallTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Martha Jimenez-VillanuevaTELEPHONE: 408-324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2024
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


Document Has Been Signed on 10/03/2024 02:08 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: M.A.O.F. GREENFIELD EARLY LEARNING CENTER
FACILITY NUMBER: 274410785

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2024
Section Cited
HSC
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision... (1)No child(ren) shall be left without the supervision..
This requirement is not met as evidenced by:
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By 10/04/2024, Site Director will submit a plan on how staff will provide proper supervision during water activities including dealing with staff having to attend to another situation, or direct supervision and cannot maintain visual supervision while monitoring the water activity.
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This requirement was not met as evidenced by C1 known behavior of placing items in their mouth, was not under supervision throughout the outdoor water activity where the child was able to ingest soap water without staff noticing or intervening and emergency medical treatment needed. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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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: Belinda DevallTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Martha Jimenez-VillanuevaTELEPHONE: 408-324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2024
LIC809 (FAS) - (06/04)
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