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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404883
Report Date: 12/19/2022
Date Signed: 12/19/2022 11:57:24 AM

Document Has Been Signed on 12/19/2022 11:57 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:HEARTS & MINDS ACTIVITY CENTERFACILITY NUMBER:
434404883
ADMINISTRATOR:ROSA BARNEONDFACILITY TYPE:
850
ADDRESS:2380 ENBORG LANETELEPHONE:
(408) 279-7515
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 28TOTAL ENROLLED CHILDREN: 21CENSUS: 10DATE:
12/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Rosa BarneondTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Marilou Monico conducted an unannounced Required - 1 Year Inspection. LPA met with Director, Rosa Barneond. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 7:30 AM to 5:30 PM. The facility serves children ages 2 years old to entry into first grade.

LPA toured both indoor and outdoor areas of the facility. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored in the upper cabinets inaccessible to children. Floors were clean. There are two (2) toilets and four (4) sinks available for the children. There is a separate staff bathroom located next to the reception area which a sick child can use if needed.

The center provides snacks and lunch to the children. There is a kitchen at the facility for food preparation. The kitchen is equipped with refrigerators, freezer, microwave, dishwasher, stove, oven, and a sink with hot and cold running water. Foods and beverages were kept protected against contamination and spoilage. Drinking water is available for the children indoor by individual water bottles, pitchers and disposable cups. Trash cans for solid waste had tight-fitting covers on, and were in good repair. Fire extinguisher, working smoke and carbon monoxide detectors were observed.


Continuation on next pages:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2022
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: HEARTS & MINDS ACTIVITY CENTER
FACILITY NUMBER: 434404883
VISIT DATE: 12/19/2022
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Rosa indicated that there are no firearms in the facility. Drinking water is readily available for the children outdoor by individual water bottles, pitchers and disposable cups. The playground is surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by trees, building overhang, pergola, and umbrellas. LPA observed rubber mulch as resilient material under and around the climbing structures. There were no bodies of water observed.

LPA reviewed 10 children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Physician's Report, Medical Assessment, Immunization, and TB test. LPA obtained copy of children's roster.

Five (5) staff files were reviewed. Staff records reviewed include Criminal Record Clearance, Personnel Record, Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Flu) and required Training. LPA reminded Director that the Assembly Bill (AB)1207 Mandated Reported Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current certifications in Pediatric CPR and First Aid.

This facility provides Incidental Medical Services – IMS. Rosa stated that none of the children enrolled is currently using any medication. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.


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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
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: HEARTS & MINDS ACTIVITY CENTER
FACILITY NUMBER: 434404883
VISIT DATE: 12/19/2022
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Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

As a result of this inspection, there were no deficiencies cited.

Exit interview conducted and report was reviewed with the Director, Rosa Barneond.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3