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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404940
Report Date: 06/24/2021
Date Signed: 06/24/2021 01:46:14 PM

Document Has Been Signed on 06/24/2021 01:46 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KIDS ON CAMPUSFACILITY NUMBER:
434404940
ADMINISTRATOR:DEBORAH GRAYFACILITY TYPE:
830
ADDRESS:2705 THE ALAMEDATELEPHONE:
(408) 554-4771
CITY:SANTA CLARASTATE: CAZIP CODE:
95053
CAPACITY: 20TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
06/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Ruiz, AlmaTIME COMPLETED:
02:00 PM
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On this day, Licensing Program Analyst (LPA) Almaraz, Celi conducted an unannounced one year annual required inspection. A risk assessment was conducted upon to entering the facility. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with Director Gray, Deborah and Assistant Director Ruiz, Alma. LPA was taken on a guided tour of this facility of both indoors and outdoors. This currently operates as an infant program which is licensed for total capacity of 20 children. This facility operates 7:30 AM-5:30 PM, Monday to Friday. The unofficial "covid" hours are 8:30 AM to 4:30 PM, Assistant Director states official hours are expected to resume in the fall (2021). This is a dual component center with a preschool license on site, License # 434404939; at the initial start of this visit, there is a total census of 8 children and a total census of 7 staff present.
PHYSICAL PLANT: This infant program consists of the following classrooms: Starfish and Otter room/s. All areas identified on the Facility Sketch were inspected. Starfish room: Upon arrival, the following staff were present: Staff #1 and #2 with 2 infants. Teacher infant ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times. Classrooms were observed to ensure that infants are never left unattended and under the direct visual supervision of a staff person at all times. This room has infants 0 to 18 months old. Infant changing tables are within an arm’s reach of two hand wash basins. LPA observed sufficient infant napping equipment that meets the requirements of Title 22 regulations and recommended covid guidelines. LPA did not observe any baby walkers or any items that fall into that category present in the facility. Storage for medication was inspected to ensure that medications are in a safe place inaccessible to children. All formulas/bottles are labeled and stored in a fridge, the temperature meets the requirements per Title 22 regulations. At this time, the Directors office and/or "empty class rooms" may be used as an isolation area. Parents are contacted immediately when children are determined to be ill. There is a fire extinguisher size 3A20BC accessible to both rooms last services 06/14/2021, rooms are adjacent. 1/4
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2021
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: KIDS ON CAMPUS
FACILITY NUMBER: 434404940
VISIT DATE: 06/24/2021
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Otter Room: Upon arrival, the following staff were present: Staff #3, #4 and #5 with 6 infant (toddlers). Teacher infant (toddler) ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times. Classrooms were observed to ensure that infants are never left unattended and under the direct visual supervision of a staff person at all times. This room has infants (toddlers)18 to 24 months old. Infant changing tables are within an arm’s reach of hand wash basin. There is one additional hand wash basin and one toilet. There are porta potties for potty training, Assistant Director states these are sanitized between each use. LPA observed sufficient napping equipment that meets the requirements of Title 22 regulations. LPA did not observe any baby walkers or any items that fall into that category present in the facility. Storage for medication was inspected to ensure that medications are in a safe place inaccessible to children. Children bring their own "cold pack" lunch. Menus are posted one week in advance where it is visible by the child's authorized representative and sent to parents via pdf file by email. Snacks were reviewed for availability, quantity and appropriateness to children in care. The facility provides AM and PM snack.

The facility was inspected to ensure that it: is clean, safe, sanitary, and in good repair to ensure the safety and well being of children, employees and staff. Furniture and equipment was inspected for good repair, free of sharp, loose, or pointed parts. The facility has age appropriate furniture and equipment including but not limited to cribs, cots/mats and changing tables. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition. Director states waste is to be discarded immediately after each meal. First Aid supplies were observed in emergency back pack in classrooms. According to Assistant, medication is only administered to a child when accompanied with a doctor's note and is stored in the office. Carbon monoxide detectors and smoke detectors are and working present in the facility. LPA observed that bottles, dishes, and containers of food brought by the infant’s authorized representatives are labeled with the infant’s name and current date. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to infants/toddlers. Per Administrator, states that there are no poisons stored inside the facility. LPA advised Administrator that storage areas for poisons need to be kept locked. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. The Administrator takes measures to keep the facility free of flies, other insects and rodents. Facility is currently taking covid precautionary measures. Temperature's are being checked. Teachers are wearing masks. Social distancing during meals and napping. Lines are sent home to wash weekly, appropriately stored and not shared. All infant/toddlers have cubby's to store belongings. 2/4

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
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: KIDS ON CAMPUS
FACILITY NUMBER: 434404940
VISIT DATE: 06/24/2021
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Playground: Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition, cushioned material and is free of hazards. The Administrator states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit. Required shade, drinking water and fencing were inspected. There is waiver on file permitting shared play space and commingling of infant and toddlers. Supervision and scheduling ensures compliance of the terms of the waiver. LPA observed facility is in compliance with the terms of the waiver. Sand box is covered each afternoon.

Facility Records: Sign in and out sheets were reviewed to ensure that children present are signed in. This is an electronic system. Last fire Drill conducted on this day (06/24/2021). Staff Records were reviewed to ensure that personnel records are maintained on all staff. Also to ensure that Teacher’s present have required infant units on file and are qualified. Children’s Records were reviewed to ensure that each child has a separate, complete, and current record, a Needs and Services Plan, and a medical assessment are on file. LPA’s observed the LIC 9227 Individual Infant Sleeping Plan in files. LPA issued the Children’s Record Review (LIC 857) and the Review of Staff records (LIC 859) to the Administrator during this inspection. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. SB792 Immunization Requirements for Staff and Employees was discussed with the Administrator. All staff have immunization documentation.

AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Administrator. Website provided: http://mandatedreporterca.com/

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Per Administrator, there are currently no children enrolled who have medication needs. 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

LPA advised the Administrator to access forms, regulations including Guardian procedures and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. and Public Health guidelines. 3/4

SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: KIDS ON CAMPUS
FACILITY NUMBER: 434404940
VISIT DATE: 06/24/2021
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The following was discussed with the Director: Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited. No infant walkers, no Johnny Jumpers, no excersaucers or any other item that falls into that category are allowed in facility.

The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Sudden Infant Death Syndrome (SIDS) and Never-Shake-a-Baby were discussed. The fire extinguisher type 3A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location. LPA provided the following documents about Safe sleep: PIN 19-02-CCP Safe Sleep Awareness Campaign and PIN 20-24-CCP Recently Approved Safe Sleep Regulations in Effect.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to obtain forms and LIVE SCAN application. Records for all children and staff must be maintained for three (3) years after separation from the facility.

The Director was also advised of the requirement to report Unusual Incidents and/or injuries to the parent/guardian and to CCL within the time frame specified by the regulation. Director advised to visit www.shotsforschool.org for immunization information. Director advised that indoor and outdoor supervision required at all times. If outdoor area not adequately fenced, provider must be with children at all times when outdoors.

There were NO Deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1
NOTICE OF SITE VISIT ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS. 4/4
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021
LIC809 (FAS) - (06/04)
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