434415602-1-25-2023-07-CC-KMEO-CNF2ZZ-20230125165110

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415602
Report Date: 01/25/2023
Date Signed: 01/25/2023 04:51:19 PM

Document Has Been Signed on 01/25/2023 04:51 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	PEPPERTREE SCHOOLS RANCH HOUSE		FACILITY NUMBER:	434415602
ADMINISTRATOR:	DANNA D MATTHEW OSBORN		FACILITY TYPE:	830
ADDRESS:	14969 LOS GATOS ALMADEN ROAD		TELEPHONE:	(408) 626-9200
CITY:	LOS GATOS	STATE: CA	ZIP CODE:	95032
CAPACITY: 32	TOTAL ENROLLED CHILDREN: 32	CENSUS: 24	DATE:	01/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Danna Matthew Osborn		TIME COMPLETED:	03:30 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	On January 25th,2023 at 3;15pm, Licensing Program Analyst (LPA) Kassandra Medrano conducted a random annual licensing inspection today. LPA met with Danna Matthew Osborn, Director the purpose of the visit was explained. The infant program is located in rooms 1,3,and 4. The facility also has a preschool license (434415601)within rooms 2 and 5. Days and hours of operation: Monday- Friday, 7am-5pm. Analyst toured the facility building and grounds, conducted an evaluation of the physical plant, and reviewed children, staff and facility records. A review of staff records during today’s visit indicates that all staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated. The facility has a fully charged fire extinguisher that meets the minimum requirements, smoke detector, and a carbon monoxide detector in the facility. Facility is adequately furnished with age appropriate toys, furniture, cribs, changing tables, and equipment. Separate staff bathrooms are available. Outdoor play area inspected for health and safety hazards; areas around and under climbing equipment is cushioned with soft rubber. If breast milk is provided by parents, it is stored appropriately in the refrigerator in an individualized bag and each bottle is labeled. Facility does not provide formula and meals, but the facility provides diapers for families. Sinks are present in the classroom as well as located near the changing tables. No pools, spas, hot tubs, fish ponds or similar bodies of water are present. Disinfectants, cleaning solutions, poisons, and toxins are inaccessible to children. Per staff, there are no firearms or weapons on site. Portable is set up for childcare and furniture and equipment for infant children is present. Adequate first aid supplies are available. Facility has posted all the required licensing forms in a prominent accessible location. LPA reviewed staff and children's files. In the files that were reviewed, all children had a medical assessment and Infant Needs and Services Plan, and Infant Care feeding plan. I

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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: PEPPERTREE SCHOOLS RANCH HOUSE	FACILITY NUMBER: 434415602
	VISIT DATE: 01/25/2023

NARRATIVE

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In the staff files, all had criminal record clearance, personnel record, and a health screening with TB test. Staff have current Pediatric First Aid and CPR certification. Staff were missing documentation of immunization. LPA reviewed with the director LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. The following items were reviewed as part of today's visit: Care and Supervision of the Children, Child Discipline Procedures, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements, Food Service, Cleaning and sanitation practices of linens, toys and equipment used In the infant center, Transportation, Parents Rights, and Reporting Requirements. Posting requirements for site visits were also discussed as well as AB 633 requirements. Facility informed that effective September 1, 2016, a person may not be employed or volunteer at a child care facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662. LPA reviewed with director the Mandated Child Abuse Reporting training as compliant with AB 1207. As of January 1, 2018, all child care staff and volunteers are required to complete Mandated Child Abuse Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com . Director was advised of the annual required pesticides training. For More information about changes to the Healthy Schools Act, templates, articles, and required training you can inspect the DPR website at: https://apps.cdpr.ca.gov/schoolipm/childcare/training/main.cfm
LPA discussed the safe sleep regulations with Director 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. She stated that she was unaware of the infant sleep logs required for 15 minute checks. LPA also informed director 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.
Current forms and Title 22 Regulations can be obtained through the internet at www.ccld.ca.gov
This facility provides IMS. A review of storage of medications, equipment and supplies, and reviewed children, personnel and administrative records.
Notice of site visit posted and shall remain posted for 30 days.
This report is reviewed with director, Danna and a copy of this report must be made available for public review upon request.

California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kassandra Medrano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 01/25/2023 04:51 PM - It Cannot Be Edited

Created By: Kassandra Medrano On 01/25/2023 at 04:30 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: PEPPERTREE SCHOOLS RANCH HOUSE	FACILITY NUMBER: 434415602
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101429(a)(2)(B)

Responsibility for Providing Care and Supervision for Infants

(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview with director, the licensee did not comply with the section cited above in that facility did not complete sleeping logs for infants in care which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/24/2023
	Plan of Correction
1 2 3 4	Director to send documentation of completion of sleeping logs

Type B

Section Cited

CCR

101217(d)

Personnel Records

(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 8 out of 8 staff files were missing documentation of immunizations which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/24/2023
	Plan of Correction
1 2 3 4	Director to send documentation of completion by staff

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:

Kassandra Medrano

LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC809 (FAS) - (06/04)

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