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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430701805
Report Date: 03/07/2023
Date Signed: 03/07/2023 10:01:34 AM

Document Has Been Signed on 03/07/2023 10:01 AM - 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:ACTION DAY NURSERIES, INC.FACILITY NUMBER:
430701805
ADMINISTRATOR:KING, HEATHERFACILITY TYPE:
850
ADDRESS:13560 S. SARATOGA-SUNNYVALE RDTELEPHONE:
(408) 867-4515
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 36DATE:
03/07/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:39 AM
MET WITH:Heather KingTIME COMPLETED:
10:15 AM
NARRATIVE
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On 03/07/2023, Licensing Program Analyst (LPA) Pete Hernandez, met with Director, Heather King , for a case management visit in regards to the lead testing results submitted by the facility and explained the reason for the visit to them. Present were 6 staff with 36 children in care.

Facility submitted that there is an exceedance of about 22 (ppb) in the preschool playground drinking fountain. Director stated the drinking fountain will be repaired but is currently disabled until that time. The facility uses bottled water for the staff and children until repairs are done and clears testing. (Director stated the water sampling company will be returning once the repair is completed to test the water again. Director stated the playground drinking fountain is not being used at this time and will be used pending upcoming test results.)

Type B deficiency was cited during today's visit. Director was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date will result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made. Exit interview conducted and report was reviewed with the Director, Heather King, A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2023
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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Document Has Been Signed on 03/07/2023 10:01 AM - It Cannot Be Edited


Created By: Pietro Hernandez On 03/07/2023 at 09:34 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ACTION DAY NURSERIES, INC.
FACILITY NUMBER: 430701805

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2023
Section Cited

101700.3(b)(1)

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101700.3(b)(1)
Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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Facility will schedule the repair to be completed by 5/10/2023 and is currently not being used. Bottled water is provided to the children and staff until the drinking fountain is repaired. Licensee will provide proof of repair and retesting to CCLD.
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Facility submitted that there is an exceedance of about 22 (ppb) in the preschool playground drinking fountain.
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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 Kuizon
LICENSING EVALUATOR NAME:Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2023


LIC809 (FAS) - (06/04)
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