434414567-3-25-2024-07-CC-FRAA-D3PLL8-20240325085042

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414567
Report Date: 03/22/2024
Date Signed: 03/25/2024 08:50:50 AM

Document Has Been Signed on 03/25/2024 08:50 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	A PLACE TO GROW		FACILITY NUMBER:	434414567
ADMINISTRATOR:	KALIN TERNIAN		FACILITY TYPE:	850
ADDRESS:	4115 JACKSOL DRIVE BUILDING 2		TELEPHONE:	(408) 265-2994
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY:	60	CENSUS: 24	DATE:	03/22/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Kalin Ternian		TIME COMPLETED:	12:40 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), Farida Raja, met with Director, Kailn Ternian for an unannounced Annual inspection and explained the purpose of today's inspection. The facility is licensed to serve children ages 2-6 years in rooms 1 to 5. The facility has one waiver on file for outdoor playground capacity to not exceed 32 children at any one time. LPA observed the required posted materials including menus and daily activity schedule in Room 5. Days and hours of operation are Monday through Friday, 7:00 am to 6:00 pm. LPA and Director toured the indoor and outdoor areas and observed the following ratios: Room 1 (Caterpillar): 7 children: 2 teachers Room 2 (Chrysalis): combined with Room 3 Room 3 (Butterflies): 13 children and 2 teachers Room 4: Office Room 5 (Dragonfly): combined with Room 3 Facility was in compliance with teacher to children ratio requirement. Classrooms, children's restrooms, staff restrooms, kitchen and office area were inspected. Children were engaged in circle time/ free play under the visual supervision of teachers. Facility has central heating/cooling for comfort of children. Director states that there are no weapons or firearms on the premises. There is a working telephone at the facility (408-626-7643). Disinfectants and cleaning products were observed stored inaccessible to the children. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. LPA observed solid waste containers in three classrooms with swing top lids. LPA informed Director that all containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof. Director ordered three trash cans with tight fitting lids during today's inspection. Continued on Page 2

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: A PLACE TO GROW	FACILITY NUMBER: 434414567
	VISIT DATE: 03/22/2024

NARRATIVE

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LPA observed appropriate changing tables that have raised sides (3 inches in height) and have vinyl changing pads that are at least 1 inch thick in Room 1. LPA observed a trash can with tight fitting cover for the disposal of diapers. Napping mats are appropriate. Restrooms and sinks for children were observed to be safe, sanitary, and in working condition. Staff has one separate bathroom in Building 3 that can be utilized by sick children if needed.

LPA observed fire extinguishers, working smoke and carbon monoxide detectors, and fire pull stations. The facility has a built-in smoke detector/ fire system. Log shows that the last Fire Drill was conducted on 02/22/2024 which is compliant with the six-month requirement for facilities.

Drinking water is readily available for children in each room and in the outdoor playground area via individual water bottles which are refilled using the kitchen water faucet. Director stated that the Cambrian School District conducted water lead testing but did not have a copy of the report to provide to LPA. Drinking water fountains were observed in the outdoor area which are not in use. Director stated that water has been turned off and requires a certain key to open the valve therefore children cannot access them.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA referred Director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Facility provides morning and afternoon snacks to the children in care. Parents provide lunch for the children. Menu was observed to be posted. Food and beverages were stored safely to prevent contamination and spoilage. Food storage and preparation areas were observed to be sanitary. All food and beverages that require refrigeration are stored in covered containers.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. Play equipment was observed to be age appropriate, in good condition and free of hazards.

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: A PLACE TO GROW	FACILITY NUMBER: 434414567
	VISIT DATE: 03/22/2024

NARRATIVE

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There are sufficient resilient tan bark material in the outdoor playground area. There are no bodies of water observed. Shade is provided by canopy and trees. Sand box was observed in good condition.

Children sign in and out logs were reviewed. Children's roster was reviewed. LPA reviewed eight (8) children’s files during today's inspection. Each child's file reviewed contained the required forms.

Four (4) staff files were reviewed. A review of staff records indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. All staff files reviewed contain the required transcripts/verification of experience. All staff files reviewed contain a current CPR and First Aid certification. 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). Staff S1 did not have proof of immunization for measles and pertussis and staff S2 did not have proof of pertussis immunization. LPA observed required Mandated Reporter Training on file for all staff.

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. Director stated that facility does not handle medications and currently has no children in care who require Incidental Medical Services (IMS). Any medications at the Facility are stored in a lock box in the kitchen refrigerator or in a lock box in a high kitchen cabinet. Isolation of sick child was discussed, and Director explained that sick children will be isolated in the director's office and isolation equipment will be provided. A staff restroom which is off limits to other children is used if necessary. Child is always under visual supervision while in care of the facility. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

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SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: A PLACE TO GROW	FACILITY NUMBER: 434414567
	VISIT DATE: 03/22/2024

NARRATIVE

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Facility does not provide transportation to children. Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Two Type B deficiencies were cited today on the attached LIC 809D pages. Appeal rights were printed and provided to Licensee. LPA reminded Licensee that failure to correct deficiencies by Plan of Correction Due Date may result in civil penalties. Exit interview conducted and report was reviewed with the Director, Kalin Ternian.

NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 03/25/2024 08:50 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: A PLACE TO GROW	FACILITY NUMBER: 434414567
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1597.16(a)(1)

Lead Testing

(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Director stated that the Cambrian School District conducted water lead testing but did not have a copy of the report to provide to LPA and was not sure if the water faucets in their preschool were tested as part of the School District testing.
	POC Due Date: 04/05/2024
	Plan of Correction
1 2 3 4	Director will obtain testing report from the School Distrist or complete water lead testing and submit report along with the required forms to LPA by 04/05/2024.

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above for two staff, S1 and S2 which poses a potential health, safety or personal rights risk to persons in care. Staff S1 is missing proof of immunizations for MMR and Tdap and S2 is missing immunization proof for pertussis.
	POC Due Date: 04/05/2024
	Plan of Correction
1 2 3 4	Director will have staff complete immunizations and submit proof to LPA by plan of correction date of 04/05/2024.

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: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

LIC809 (FAS) - (06/04)

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