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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408755
Report Date: 07/19/2022
Date Signed: 07/19/2022 02:55:56 PM

Document Has Been Signed on 07/19/2022 02:55 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:ACTION DAY PRIMARY PLUSFACILITY NUMBER:
434408755
ADMINISTRATOR:RITIPAL(NEEKA)JUNEJAFACILITY TYPE:
850
ADDRESS:5845 ALLEN AVENUETELEPHONE:
(408) 629-6020
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 254TOTAL ENROLLED CHILDREN: 179CENSUS: 157DATE:
07/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Georgia AndresenTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analysts (LPA's) Janette Cruz and Samantha Yip conducted an unannounced case management visit to the facility today. LPA's observed 157 children and 23 staff present. LPA's met with Georgia Andresen, Assistant Site Director, and explained to her the purpose of today's visit was to evaluate qualifications of facility's current Director, Britney Lawrence.

On 4/22/22, the Department received an e-mail from Jenna Valadao, facility Director of Child Development Programs notifying the Department that Britney Lawrence was taking the facility director's role. LPA Yip responded to Jenna's email on 4/22/22 and 6/6/22, following-up on required documentation to complete Britney's site director qualifications but as of present, qualification documents remain incomplete. LPAs reviewed transcript and observed that Britney was registered to complete ECE 110: Admin & Supervision of ECE II the Spring of 2013. However, there is no proof that course was completed.

LPA's reviewed current staff file for Britney Lawrence, the following qualification documents were not available upon review:
1. Current Pediatric CPR / First Aid Card
2. Proof of ECE unit : Administration/Staff Relations

Exit interview was conducted with Georgia Andresen.

As a result of today's inspections, deficiencies were cited. See 809D.

A Notice of Site Visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2022
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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Document Has Been Signed on 07/19/2022 02:55 PM - It Cannot Be Edited


Created By: Janette Cruz On 07/19/2022 at 01:46 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: ACTION DAY PRIMARY PLUS
FACILITY NUMBER: 434408755

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2022
Section Cited
CCR
101215.1(h)(2)(a)

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Child Care Center Directors Qualifications and Duties
(h) Child care center directors shall have completed one of the following prior to employment:
2(A) Three semester or equivalent quarter units shall be in administration or staff relations.
This requirement is not met as evidenced by:
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Licensee will submit to LPA Cruz proof of completed administration/ staff relations unit for staff assuming Director role.
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Based on record review, Licensee did not comply with the section cited above. Staff assuming Director's role does not have proof of administration/staff relations units to complete director's qualifications, which poses a potential health and safety risk to children in care.
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Type B
07/26/2022
Section Cited
HSC1596.866(A)(2)

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In addition to other required training, at least one director or teacher at each day care center...shall have at least 15 hours of health and safety training,...
(2) The training shall include the following components:
(A) Pediatric first aid.
(B) Pediatric cardiopulmonary resuscitation (CPR)
This requirement is not met as evidenced by:
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Licensee will submit to LPA Cruz proof of current Pediatric First Aid and CPR for the staff assuming Director's role.
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Based on record review, Licensee did not comply with the section cited above. Staff assuming Director's role does not have proof of current Pediatric First aid and CPR on File, which poses a potential health and safety risk to children in care.
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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:Diana Stephenson
LICENSING EVALUATOR NAME:Janette Cruz
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2022


LIC809 (FAS) - (06/04)
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