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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406740
Report Date: 09/01/2021
Date Signed: 09/01/2021 04:37:30 PM

Document Has Been Signed on 09/01/2021 04:37 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 PLUSFACILITY NUMBER:
434406740
ADMINISTRATOR:FUENTES, RICHARDFACILITY TYPE:
850
ADDRESS:3500 AMBER DRIVETELEPHONE:
(408) 248-2464
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 17DATE:
09/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Katherine CalioTIME COMPLETED:
03:57 PM
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Licensing Program Analyst (LPA), Pete Hernandez, conducted a Required 1 Year inspection. LPA met with Teacher, Katherine Calio, Director, Zoila Mauseth was not present but returned around 2:00 PM. The center is located at Primary Plus Preschool site. Operating hours are 7:30AM to 5:30 PM Monday through Friday. LPA observed all the required posted materials.

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. Katherine provided a copy of the fire drill record, sign in and out records and the children's roster to the LPA.
LPA reviewed six children's files. Each child's file reviewed contains the required information. LPA reviewed 5 staff files and found that all 5 have NOT completed ,nor kept it current, 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 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 17 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 08/20/2021):
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 09/01/2021
NARRATIVE
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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/20/2021):
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.
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 7/23/2021.
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 materials (wood chips) 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: Sandy Knight
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
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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: 09/01/2021
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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/20/2021):

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 (provide name) 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 (provide name) 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.

LPA/s also discussed "zero tolerance" related regulations with the Licensee/Director, (provide name) and was advised of the assessment for an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

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, Donna Jackson, 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: Sandy Knight
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
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Document Has Been Signed on 09/01/2021 04:37 PM - It Cannot Be Edited


Created By: Pietro Hernandez On 09/01/2021 at 02:40 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: 09/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/15/2021
Section Cited
HSC
1596.8662(b)(1)

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On or before March 30, 2018, a person who on, January 1, 2018, is a licensed child care provider, administrator, or employee if a licensed child day care facility shall complete the mandated reporter training […] and shall complete renewal […] every two years […]
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LPA provided the web address https://www.mandatedreporterca.com for Licensee to access the required training. BY POC DUE DATE Licensee, Teachers and Support Staff will complete the training and send a copy of the Certificate of Completion to Licensing Office.
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This requirement is not met as evidenced by: Based on today’s inspection, Director and Teachers, support staff do not have completed Mandated Reporter Training AB 1207. Licensee stated that she was unaware of this requirement. This poses a potential risk to the children.
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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:Sandy Knight
LICENSING EVALUATOR NAME:Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/01/2021 04:37 PM - It Cannot Be Edited


Created By: Pietro Hernandez On 09/01/2021 at 03:34 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: 09/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2021
Section Cited
HSC
1596.954

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Every licensed child day care center shall have one or more carbon monoxide detectors [...]The department shall account for the presence of these detectors during inspections.This requirement has not been met as evidenced by:
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BY POC DATE: The Director must provide proof of having installed one or more cabon monoxide detectors to CCLD.
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The Facility did not have any carbon monoxide detectors. This poses a potential risk to the health and safety of children.
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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:Sandy Knight
LICENSING EVALUATOR NAME:Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/01/2021


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