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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710222
Report Date: 04/03/2024
Date Signed: 04/03/2024 11:46:53 AM

Document Has Been Signed on 04/03/2024 11:46 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PRIMARY PLUS, INC.FACILITY NUMBER:
430710222
ADMINISTRATOR:
ADMINISTRATOR/
DIRECTOR:		JENNA FENNELLFACILITY TYPE:
850
ADDRESS:1125 WEST CAMPBELL AVETELEPHONE:
(408) 379-3184
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 320TOTAL ENROLLED CHILDREN: 141CENSUS: 129DATE:
04/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
TIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Alyssa ContrerasTIME COMPLETED:
TIME VISIT/
INSPECTION COMPLETED:
11:56 AM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with the Site Director, Alyssa Contreras, and explained the purpose of the visit. Upon arrival, LPA was admitted into the facility by office staff.

During review of documents, it was discovered that the facility does not have their admission policies in writing and available as required per Section 101218. LPA advised that the policies shall include written admission criteria designating those children whose needs can be met by the centers programs and services, the ages of children accepted, field trip provisions, transportation arrangements, and the requirement for medical assessment for admission. Additionally, upon review of the facilities admission agreement, LPA advised that per Section 101219, it is missing the following specifications: available optional services, optional services rates, payor, the right of the Department to perform duties specified in Sections 101200(b)/(c) and conditions under which the contract may be terminated. LPA advised the Site Director to review the sections to ensure that all required topics are included in both the admission agreement and admission policies.

LPA advised that if Alyssa shall act as assistant infant director, she shall also complete three (3) semester units relating to the care of infants. LPA reminded that per Section 101215.1, the Site Director shall be on the premises during the hours the center is in operation.

As a result of today’s inspection, deficiencies have been cited, see LIC809-D.

Exit interview conducted and the report was reviewed with the Site Director, Alyssa Contreras.

A NOTICE OF SITE VISIT WAS GIVEN AND SHALL BE POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2024
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 04/03/2024 11:46 AM - It Cannot Be Edited


Created By: Cortney Nelson On 04/03/2024 at 10:47 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: PRIMARY PLUS, INC.
FACILITY NUMBER: 430710222

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2024
Section Cited
CCR
101219(b)

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101219 Admission Agreements (b) Admission agreements shall specify the following:

This requirement was not met as evidenced by:
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The facility shall update their admission agreement and submit revised version to the Department by 4/19/2024. The revised admission agreement shall be used moving forward for enrolling parents into both the preschool and infant program.
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The facility did not specify all of the requirements of this Section as the Admission Agreement was missing (2), (3)(B), (3)(C), (6) and (7), which poses a potential risk to the health, safety, and personal rights of children in care.
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Type B
04/19/2024
Section Cited
CCR101218(a)

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101218 Admission Policies (a) Every child care center shall have all admission policies in writing and available to the public. The policies...shall include, but not be limited to, the following:

This requirement was not met as evidenced by:
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The facility shall update their policies page and include all sections indicated that are missing to meet the regulatory requirements. Updated policies to be submitted to the Department by 4/19/2024.
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The facility did not include all policies required by this Section and during review, LPA observed the policies are missing (1), (2), (5), (6), and (8), which poses a potential risk to the health, safety, and personal rights of children in care.
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Updated policies shall be added to the admission folder for infant and preschool parents and be available when requested.
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:Joel Segura
LICENSING EVALUATOR NAME:Cortney Nelson
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024


LIC809 (FAS) - (06/04)
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