434414670-11-26-2024-07-CC-JBER-DBDT7B-20241126132829

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434414670
Report Date: 11/26/2024
Date Signed: 11/26/2024 01:28:47 PM

Document Has Been Signed on 11/26/2024 01:28 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ACTION DAY PRIMARY PLUS		FACILITY NUMBER:	434414670
ADMINISTRATOR/ DIRECTOR:	BATE, STEPHANIE		FACILITY TYPE:	830
ADDRESS:	2174 LINCOLN AVENUE		TELEPHONE:	(408) 266-8188
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY: 50	TOTAL ENROLLED CHILDREN: 50	CENSUS:	DATE:	11/26/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:50 AM
MET WITH:	Jamie Ferguson		TIME VISIT/ INSPECTION COMPLETED:	01:40 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), Jennifer “Jen” Beehler, met with Directors Jenny Do & Jamie Ferguson, for an unannounced Required- 1 Year Inspection. LPA was granted access to the facility by the Facility Representative and toured both indoors and outdoors during the inspection. Upon arrival, there were 35 children (infants) and 10 staff present, which is compliant with the facility license capacity and ratio requirements. LPA observed all required postings at the main office entrance for the facility. Hours of operation for the facility are Monday – Friday, 07:00AM-06:00PM. There is an active waiver for electronic sign in/out for parent/child drop off. Facility Representative 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. LPA observed all staff to be background checked and criminal record cleared during today's visit. LPA reviewed sign-in/out sheets and found the definition of relationship to child was inaccurate, stating that it was a teacher or administrator signing out children. However, LPA observed parents full names listed. LPA suggested to facility to review the electronic system to insure all information is accurate. LPA reviewed the facility roster that was in a corporate format and not the LIC9040 document. LPA requested the facility transfer this information to an LIC9040 as document was missing doctor's information and child's home address. The last fire/disaster drill was conducted on 08/21/2024, which is compliant with the six month requirement for facilities. LPA observed a fully charged 3A40BC fire extinguisher which was last serviced 12/13/2023 which is compliant with fire marshal fire regulations. LPA observed a fully functioning CO2 detector in both classrooms. Facility representative confirmed there are no guns or weapons on site. Continued on Page 2

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ACTION DAY PRIMARY PLUS	FACILITY NUMBER: 434414670
	VISIT DATE: 11/26/2024

NARRATIVE

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Facility Representative states that she does currently have children in care who require Incidental Medical Services. Medication is properly stored out of reach of children, in an upper cabinet in the kitchen, with the proper documentation. LPA observed the prescription and doctor's directives stored with the medication.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records.
For IMS information see PIN 22-02-CCP. 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/.

Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. The floors were clean and free of tripping hazards. Drinking water is readily available for children in the facility via water filters and reusable bottles from home labeled with the children’s names. Staff and children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom. The Facility has a working telephone. Cleaning and maintenance for the facility is conducted by an outside service and is completed in the evenings after all day care children have left the premises every evening, Monday through Friday.

Infant Safe Sleep regulations (PIN 20-24-CCP) was discussed with the Facility Representative, including the Individual Infant Sleeping Plan (LIC9227). LPA reminded Facility Representative that infants up to 12 months of age should be placed on their back to sleep, that cribs should be free of all loose articles and hanging objects, and that infants should not be swaddled. Infants should be supervised while sleeping and documentation of sleep checks every 15 minutes should remain in the infant’s file. Documentation should include the time of the check, the infant’s physical condition, and initials of the staff member checking on the infant. LPA observed completed infant sleep checks but the information was missing a place to state infant's condition. LPA reminded staff of this requirement and suggested the documentation is updated to include space to record condition. Continued on Page 3

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ACTION DAY PRIMARY PLUS	FACILITY NUMBER: 434414670
	VISIT DATE: 11/26/2024

NARRATIVE

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LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

The outdoor area of the facility was inspected and observed to be fenced in. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient material to absorb falls and has astro-turf over the top. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by canopies.

AM/PM snacks are provided by the facility and are stored, prepared, and served in a safe and healthful manner to the children. Parents provide a lunch from home. Lunch boxes are safely stored and are labeled with children's names. Menu is in writing and posted at least one week in advance, accessible to authorized representatives. The kitchen and storage area is clean and free of litter and rubbish. Equipment necessary for the storage, preparation and service of food is well maintained, clean, and sanitized after each use.

10 children’s file (infants) were reviewed during today’s inspection for the following records: Physician’s Report (LIC701), Notification of Parents Rights (LIC995A), Consent for Emergency Medical Treatment (LIC627), Acknowledgment of Receipt of Licensing Report (LIC9224) from 08/08/2024, Signed Admission Agreement, Identification and Emergency Information (LIC700) and Immunization Records (PM286). When reviewing infant’s files, LPA observed Individual Infant Sleep Plan (LIC9227) and sleep check documentation were present. LPA observed 8/10 children's files to be complete. LPA observed 2/10 children's files missing the MMR vaccination for children that are over the age of 12 months.

Continued on Page 4

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ACTION DAY PRIMARY PLUS	FACILITY NUMBER: 434414670
	VISIT DATE: 11/26/2024

NARRATIVE

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5 staff files (teachers) were reviewed for the following records: Transcripts/Verification of Experience, Health Screening Report (LIC503), Employee Rights (LIC9052), Statement Acknowledging Requirement to report Child Abuse (LIC9108), Mandated Reporter Training Certificate, Tuberculosis (TB) Clearance, and Immunization Record showing immunity to measles (MMR), pertussis (Tdap), and influenza (or statement declining influenza). There is at least one staff member present with current CPR/First-Aid that expires 05/19/2025. LPA reminded Facility Representative that the Mandated Reporter Training for Child Care Providers must be renewed by all staff every 2 years and satisfy the requirement of AB1207. 5/5 staff files were complete.

The Facility representative understands that the site director shall be on the premises during the hours the center is in operation and that children at the center shall be visually supervised at all times. LPA reminded Facility Representative that there shall be at least one person with valid CPR and First-Aid certifications on site at all times.

Due to today's inspection one Type B citations have been issued, more details provided in the attached LIC-809D. Exit interview conducted with facility representatives, Jamie Ferguson and Brittany Strange - report reviewed and provided along with Appeal Rights.

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

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:	DATE: 11/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/26/2024 01:28 PM - It Cannot Be Edited

Created By: Jennifer Beehler On 11/26/2024 at 01:07 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: 434414670
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(B)(1)

(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following: (1) Labored breathing. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 10 out of 10 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/13/2024
	Plan of Correction
1 2 3 4	Facility will create a new sleep log that includes a place to record child's breathing.

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:

Jennifer Beehler

LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024

LIC809 (FAS) - (06/04)

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