434406740-8-2-2022-07-CC-PHEZ-CGWRET-20220802125805

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434406740
Report Date: 08/02/2022
Date Signed: 08/02/2022 12:58:17 PM

Document Has Been Signed on 08/02/2022 12:58 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:	PRIMARY PLUS		FACILITY NUMBER:	434406740
ADMINISTRATOR:	FUENTES, RICHARD		FACILITY TYPE:	850
ADDRESS:	3500 AMBER DRIVE		TELEPHONE:	4082482464
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95117
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 26	CENSUS: 21	DATE:	08/02/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Katheryn Muniz		TIME COMPLETED:	01:29 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), Pete Hernandez, conducted a Required 1 Year inspection. LPA met with new Director Katheryn Muniz, was not present but returned around 2:00 PM. The center is located at Primary Plus Preschool site. Operating hours are 6:30AM to 6:00 PM Monday through Friday. LPA observed all the required posted materials. There is one Active Waiver on file allowing preschool and school-age children to share bathroom at separate times. Room 18 had one Teacher and an Float/Aide watching 12 children. Room 17 had one Teacher watching 9 children. LPA toured the Facility both inside and outside during today's visit. LPA notes that the Facility is licensed but currently only has 2 preschool rooms in use: Rooms 17 and 18. The playground is in good condition with shock absorbing material under the climbing equipment. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menu, and Activity Schedule. The facility has one waiver on file for electronic sign in/ out. Katheryn Muniz provided a copy of the fire drill record with last entry dated 6/27/2022. The sign in and out records and the children's roster were provided to the LPA. LPA reviewed (10) Ten children's files. Each child's file reviewed contains the required information. LPA reviewed 4 staff files All were complete except one. The required Mandated Reporter Training (AB1207) and the required immunization's against Pertussis, Measles, and Influenza (or opt out letter). There is at least one teaching staff member that has current CPR and First Aid certifications on file. DIrector's First Aid and CPR expires 9/7/2023. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). There were 21 preschool children present during today’s inspection. However, Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 08/02/2021):

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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: PRIMARY PLUS	FACILITY NUMBER: 434406740
	VISIT DATE: 08/02/2022

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/02/2022):
LPA reminded the Director of applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12-month period. A review of staff records today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions: Except for one.
LPA observed that the room is clean and safe for all children and staff. Katherine states that the schools custodial team cleans the preschool rooms Monday through Friday in the evenings during the school year. Drinking water is readily available for the children inside via two water fountains and outside via personal water bottles. LPA observed solid waste containers with tight-fitting lids in the classrooms. Children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Katherine states that there are no weapons or firearms on the premises.
The Preschool provides AM and PM snacks and though most of the children bring their lunch from home, the school does offer a hot lunch, from the on site school cafeteria, upon request by the parent. The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. Cleaning supplies are inaccessible to the children and stored in locked cabinets inaccessible to children. Any medications at the Facility are stored in the Directors office. LPA observed a Fire Drill log with the last fire drill being conducted on 6/27/22.
LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. The resilient shock absorbent materials in the outdoor playground area are sufficient. LPA did not observe any bodies of water.
LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regard to new regulations. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list childcareadvocatesprogram@dss.ca.gov. LPA discussed Assembly Bill (AB) 2370 and gave Lead Safety information.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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: PRIMARY PLUS	FACILITY NUMBER: 434406740
	VISIT DATE: 08/02/2022

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/02/2022):

The facility has an IMS program on record is not currently caring for any children with medication needs.

LPS/s discussed the requirements of AB 633 with the Licensee/Director Katheryn Muniz and provided the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the Licensee/Director understands the requirements. Upon receipt, Licensee/Director Katheryn Muniz shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Type A language: Upon the issuance of Type A citations, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, A copy of this report and appeals rights were discussed and left with the Licensee, Katheryn Muniz, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/02/2022 12:58 PM - It Cannot Be Edited

Created By: Pietro Hernandez On 08/02/2022 at 12:00 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PRIMARY PLUS	FACILITY NUMBER: 434406740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

101170(e)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	S-1 has been allowed to work in the facility as a staff member prior to obtaining criminal record clearance. This presents an immediate risk to health and safety of the children in care.
	POC Due Date: 08/09/2022
	Plan of Correction
1 2 3 4	Effective immediately the Director shall ensure that S-1 will not be permitted to work prior to obtaining a criminal record clearance and being associated to the facility. To be completed by the end of the day by the POC due date, the Director shall submit a written plan to Community Care Licensing outlining how the facility will ensure all staff employed by the facility are cleared and associated.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Pietro Hernandez

LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC809 (FAS) - (06/04)

Page: 2 of 5

Document Has Been Signed on 08/02/2022 12:58 PM - It Cannot Be Edited

Created By: Pietro Hernandez On 08/02/2022 at 12:00 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PRIMARY PLUS	FACILITY NUMBER: 434406740
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/02/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	This requirement is not met as evidenced by: Based on today’s inspection, Assistant Provider S-1 does not have completed Mandated Reporter Training AB 1207. This poses a potential risk to the children.
	POC Due Date: 09/20/2022
	Plan of Correction
1 2 3 4	LPA provided the web address https://www.mandatedreporterca.com for Licensee to access the required training. BY POC DUE DATE : Assistant Provider S-1 will complete the training and send a copy of the Certificate of Completion to Licensing Office.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Pietro Hernandez

LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

LIC809 (FAS) - (06/04)

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