<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430703144
Report Date: 06/12/2025
Date Signed: 06/12/2025 03:02:36 PM

Document Has Been Signed on 06/12/2025 03:02 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:ACTION DAY NURSERY-PRIMARY PLUSFACILITY NUMBER:
430703144
ADMINISTRATOR/
DIRECTOR:		JESSICA GUZMANFACILITY TYPE:
830
ADDRESS:333 EUNICE AVENUETELEPHONE:
(650) 967-3780
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY: 60TOTAL ENROLLED CHILDREN: 65CENSUS: 45DATE:
06/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Jessica GuzmanTIME VISIT/
INSPECTION COMPLETED:
03:20 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
On 06/12/2025 at approximately 10:40am, Licensing Program Analyst (LPA) Kassandra Medrano met with Site Director, Jessica Guzman, for an unannounced Case Management Inspection. The purpose of the inspection was to discuss an unusual incident that occurred on 04/24/2025; Oakland South Regional Office (OSRO) received written documentation of the incident on 05/01/2025. At approximately 11:00am, during tour of facility it was observed that facility was currently installing fences on the property but had not notified OSRO.

On the day mentioned above, an incident occurred where threatening and inappropriate language was found on the facility's parent portal- "Preschool2Me." A lock down was initiated by Action Day Staff, and Mountain View Police Department (MVPD) responded to the allegation and began their investigation. The investigation by MVPD remains ongoing. Based on information available, Facility did not appropriately notify OSRO about the incident that occurred. As well as, on 4/25/25, facility representatives found a bottle of alcohol in a cabinet within a classroom, which was accessible to children and belonged to S1. Per facility representatives, the alcohol could not be reached by children in that classroom. Action Day School staff have addressed the concern and have followed the schools policies and procedure's regarding alcohol on campus.

During inspection, LPA obtained copies of children's roster, staff roster, and other documents pertaining to the incident listed above.



A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Facility representative, Jessica.

California Code of Regulations, Title 22 deficiencies are being cited on the following pages:
NAME OF LICENSING PROGRAM MANAGER: Wynn Norona
NAME OF LICENSING PROGRAM ANALYST: Kassandra Medrano
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2025
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 3
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 3
Document Has Been Signed on 06/12/2025 03:02 PM - It Cannot Be Edited


Created By: Kassandra Medrano On 06/12/2025 at 02:00 PM
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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: ACTION DAY NURSERY-PRIMARY PLUS
FACILITY NUMBER: 430703144

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/26/2025
Section Cited
CCR
101212(d)

1
2
3
4
5
6
7
101212(d) Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Director stated she understood the requirements of reporting and would communicate that to her corporate office. Director agreed to send in written documentation informing OSRO of fence installation.
8
9
10
11
12
13
14
Based on record review and interviews with staff that facility did not ensure that a call was made within 24 hours of the incident. As well as facility did not notify OSRO about installation of fences. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
Type B
06/26/2025
Section Cited
CCR101238(g)

1
2
3
4
5
6
7
101238(g) Building and Grounds
(g)Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Director agreed to conduct a training for staff and provide written documentation of what is covered in training as well as have staff that recieve training sign documenting understanding.
8
9
10
11
12
13
14
Based on interviews, on 4/25/2025, a plastic water bottle filled with alcohol was found on a middle shelf in an unlocked cabinet. When it was found it was removed from the classroom, and confirmed by MVPD that it was alcohol. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wynn Norona
NAME OF LICENSING PROGRAM MANAGER:
Kassandra Medrano
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2025


LIC809 (FAS) - (06/04)
Page: 3 of 3