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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415767
Report Date: 04/04/2023
Date Signed: 04/05/2023 04:31:40 AM

Document Has Been Signed on 04/05/2023 04:31 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CHILDREN'S COURTYARD, THEFACILITY NUMBER:
434415767
ADMINISTRATOR:ANNABELLE CALASANZFACILITY TYPE:
850
ADDRESS:610 E DUNNE AVENUETELEPHONE:
(408) 778-1977
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 70DATE:
04/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Annabelle CalasanzTIME COMPLETED:
06:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Assistant Director Rocio Andrade and explained the reason for the inspection. Director Annabelle Calasanz arrived shortly after. There were 70 children and at least twelve (12) staff present.

There is a board to post required posting, such as notification of parent's rights and car seat law. License is posted by the front door. The hours of operation are Monday through Friday 6:30AM to 6:30PM. LPA reviewed electronic sign in/sign out.

LPA toured the inside and outside of the facility with Assistant Director Rocio. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible to children. There are toys and equipment for children. Floors were observed to be clean and free of tripping hazard. Bathroom for children were observed to be functioning. There is fire extinguisher, smoke detector, and a carbon monoxide detector. The last fire/disaster drill was conducted on 02/2023. Director stated that there are no weapons, such as firearms, stored at the facility.

The outdoor area is fenced. Areas around play structure have resilient material. Shaded rest area is provided through trees and canopy. There were no bodies of water observed during today's inspection. Drinking water outside is provided through water fountains.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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: CHILDREN'S COURTYARD, THE
FACILITY NUMBER: 434415767
VISIT DATE: 04/04/2023
NARRATIVE
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---------------continuation of 809 dated 04/04/2023 page 1----------------------

Facility provides meals and snacks to children. There is a menu posted. Kitchen used to prepare meals and snacks had hot and cold running water. Drinking water inside is provided through water bottles and Brita filter and cups.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Medications were not in the original packaging. The prescription medication expired on 02/03/2023. Director notified parent regarding the expired medication. LPA discussed that medication needs to be in the original packaging and for non-prescription medication that it needs to have the child's name on it. 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

A copy of the facility roster was obtained during today's inspection. 12 children's files were reviewed during today's inspection. The records reviewed include but not limited to physician's report, admission agreement, and immunization records. LPA discussed about ensuring that forms are accurate and signed.

Seven (7) staff files were reviewed during today's inspection. The records reviewed during today's inspection were Mandated Reporter training and education credit. There is a staff who completed the CPR/1st Aid. CPR/1st Aid was completed through Medic 1st Aid and does not have verification that it is EMSA approved. Director will send proof of a staff with a valid CPR/1st Aid.

-----------------continues on 809 dated 04/04/2023 page 3--------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
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Page: 2 of 5
Document Has Been Signed on 04/05/2023 04:31 AM - It Cannot Be Edited


Created By: Samantha Yip On 04/04/2023 at 04:47 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: CHILDREN'S COURTYARD, THE
FACILITY NUMBER: 434415767

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(3)(A)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one out of one objects, which poses a potential health, safety or personal rights risk to persons in care. Prescription medication expired on 02/2023.
POC Due Date: 04/11/2023
Plan of Correction
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By POC 04/11/2023, Director will submit proof that an updated medication will be provided to the facility. Director will send proof once medication is obtained.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


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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: CHILDREN'S COURTYARD, THE
FACILITY NUMBER: 434415767
VISIT DATE: 04/04/2023
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S-1 was present at the facility. Director stated that S-1 does help out in the classroom. S-1's fingerprints were separated from the facility. Director transferred S-1's fingerprints during today's inspection. Director was reminded that all adults 18 and over, 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.

As a result of this inspection, a Type A and a Type B citation were issued. A civil penalty of $500 was issued for caregiver background check. An exit interview conducted and report was reviewed with Director Annabelle Calasanz. A notice of site visit has been issued and must be posted for 30 days.

LPA Samantha Yip informed Director Annabelle Calasanz that this report dated 04/04/2023 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Director, Annabelle, to provide a copy of this licensing report dated 04/04/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 04/05/2023 04:31 AM - It Cannot Be Edited


Created By: Samantha Yip On 04/04/2023 at 05:40 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: CHILDREN'S COURTYARD, THE
FACILITY NUMBER: 434415767

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)(2)
Criminal Record Clearance All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 101170(f)...

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above, which posed an immediate health, safety or personal rights risk to persons in care. S-1 has cleared fingerprints, but was not associated to the facility.
POC Due Date: 04/04/2023
Plan of Correction
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Deficiency corrected during today's inspection. Director associated S-1 to facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2023


LIC809 (FAS) - (06/04)
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