434404978-9-9-2022-07-CC-SYIP-CJ4KKL-20220909075831

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404978
Report Date: 09/07/2022
Date Signed: 09/09/2022 07:58:35 AM

Document Has Been Signed on 09/09/2022 07:58 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:	LOS ARROYOS CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	434404978
ADMINISTRATOR:	OKSANA OKS		FACILITY TYPE:	850
ADDRESS:	885 MORO DRIVE		TELEPHONE:	(408) 843-9005
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY: 96	TOTAL ENROLLED CHILDREN: 96	CENSUS: 47	DATE:	09/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:37 AM
MET WITH:	Oksana Oks		TIME COMPLETED:	02:25 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	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required 1 Year inspection. LPA met with Director Oksana Oks and explained the reason for the inspection. Present during today's inspection were 47 children and at least 9 staff. Facility was within ratio during today's inspection. Facility operates in Room 1, Room 2, and Room 3. Director stated that they currently do not run their state preschool. There is a board to post required postings, such as license, parent's rights, car seat law, notification of parent's rights, and facility sketch. There is working phone at the facility. The hours of operation are Monday through Friday 7AM to 6PM. LPA reviewed sign in/sign out. LPA toured the inside and outside of the facility. Cleaning supplies were observed to be inaccessible to children. LPA observed that there were containers of Swifter wet wipes under the sink in Room 3 and a container of disinfectant wipes under the sink in Room 2. The containers were moved to an inaccessible area. LPA reminded Director that anything that states to keep out of reach of children needs to be inaccessible. Toys and equipment were observed to be age appropriate. LPA observed in Room 1 that there was flour around the sensory table that could pose a slipping hazard. LPA also observed in Room 2 that there was sand around the sensory table that could pose a slipping hazard. LPA discussed with the Director about ensuring that staff are sweeping after ---------------------continues on 809 dated 09/07/2022 page 2----------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

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 5

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: LOS ARROYOS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434404978
	VISIT DATE: 09/07/2022

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
26
27
28
29
30
31
32

------------------continuation of 809 dated 09/07/2022 page 1---------------------

sensory table is used. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last disaster drill was conducted on 07/07/2022. Director stated that there are no weapons, such as firearms, stored on the premise. At 10:58AM, LPA observed that staff brought a child to the bathroom in Room 2. Staff was standing by the door. LPA discussed with Director about ensuring that staff can visually supervise children in the bathroom.

The outdoor area is fenced. Shaded rest area is provided through canopy, umbrellas, building overhand, and pergola. Facility has a waiver to outdoor square footage and to share the school-age yard. Area around play structure have resilient material. LPA observed that the rubber mulch by the tunnel is starting to have a hold and that there are areas where the rubber mulch needs repair. LPA discussed with Director about their plan for the rubber mulch. LPA reminded Director about emptying any sensory table with water after use. There were no bodies of water observed during today's inspection.

Facility provides meals and snacks to children. Drinking water is provided through individual water bottles. There is a kitchen to prepare and store food. Trash can for waste have tight fitted lids.

Facility does provide Incidental Medical Services. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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

---------------------continues on 809 dated 09/07/2022 page 3---------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: LOS ARROYOS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434404978
	VISIT DATE: 09/07/2022

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
26
27
28
29
30
31
32

--------------continuation of 809 dated 09/07/2022 page 2-----------------------

A copy of the facility roster was obtained. 10 children's files were reviewed during today's inspection. The record reviewed include but not limited to physician's report, immunization, and consent for emergency medical treatment. LPA observed that C-1 and C-2 had a typo on the LIC 627: Consent for Emergency Medical Treatment.

10 staff files were reviewed during today's inspection. The records reviewed included but not limited to Mandated Reporter training and education transcript. There is at least one staff with a valid CPR/1st Aid. Director's CPR/1st Aid expires on 08/12/2023. A copy of the LIC 500: Personnel Report was obtained during today's inspection. LPA observed that S-1 only had Mandated Reporter General Training certificate on file. Director will send Child Care Provider training certificate to Licensing.

All staff present have cleared fingerprints. 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.

As a result of this inspection, two technical violations were issued. Exit interview conducted and report was reviewed with Director Oksana Oks. 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: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022

LIC809 (FAS) - (06/04)

Page: 3 of 5