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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415769
Report Date: 04/04/2023
Date Signed: 04/05/2023 04:33:20 AM

Document Has Been Signed on 04/05/2023 04:33 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:
434415769
ADMINISTRATOR:ANNABELLE CALASANZFACILITY TYPE:
830
ADDRESS:610 E DUNNE AVENUETELEPHONE:
(408) 778-1977
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 13DATE:
04/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Annabelle CalasanzTIME COMPLETED:
02:00 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. Present during today's inspection were 13 infants and at least six (6) staff.

There is 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 toured the inside and outside of the facility with Assistant Director Rocio. All disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to inaccessible to children. There are toys and equipment for children. There are high chairs for children that can be cleaned and wiped. Changing table was within arms reach of a sink and had padding and a siding that was at least 3 inches high. There were no baby walkers observed during today's inspection. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Director stated that there are no weapons, such as firearms, stored at the facility.

The outdoor area is fenced. Area around equipment have resilient material. Shaded rest area is provided through tree and canopy. There were no bodies of water observed during today's inspection.

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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: 434415769
VISIT DATE: 04/04/2023
NARRATIVE
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LPA reviewed the 15 minute sleep check. There were four infant under 12 months. All infant did not have LIC 9227: Individual Infant Sleeping Plan on file. LPA discussed the safe sleep regulations with the 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. 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.

Meals and snacks are either prepared and brought from home or provided by the facility. Kitchen used to prepare meals and snacks had hot and cold running water. Menu was observed to be posted. There is an area to prepare meals and bottles that is separate from the changing table. There is also a fridge to store meals and bottles. LPA discussed with Director that all containers and bottles need to be labeled with the infant's name and the current date. There were bottles and containers in the fridge that was not labeled. Drinking water is provided through sippy cups.

The center currently does not provide Incidental Medical Services (IMS). For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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



---------------continues of 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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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: 434415769
VISIT DATE: 04/04/2023
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A copy of the facility roster was obtained. Six (6) children's files were reviewed during today's inspection. The records reviewed include but not limited to Needs and Service Plan, admission agreement, and immunization records. There were four children who did not have needs and service plan on file. Two of the children's needs and service plan was not updated quarterly. LPA discussed with the Director that needs and service plans need to be updated quarterly.

Three (3) staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit and mandated reporter training. There is a staff who completed the CPR/1st Aid through Medic 1st Aid, but did not have proof that is EMSA approved.

All staff present have cleared fingerprints. 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, type B citations were issued. 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.
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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Document Has Been Signed on 04/05/2023 04:33 AM - It Cannot Be Edited


Created By: Samantha Yip On 04/04/2023 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: CHILDREN'S COURTYARD, THE
FACILITY NUMBER: 434415769

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101430(a)(3)(A)(4)
Infant Care Activities
(A) Staff shall place infants up to 12-months of age on their backs for sleeping. (4) Infants with an Individual Infant Sleeping Plan [LIC 9227 (3/20)] that have Section C of the form completed and signed by an authorized representative shall be placed on their back when first laid down to sleep. In the event the infant changes position, the infant may remain in the alternative position.

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 four out of four persons which poses a potential health, safety or personal rights risk to persons in care. Four infants under 12 months did not have LIC 9227 on file.
POC Due Date: 04/11/2023
Plan of Correction
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By POC 04/11/2023, Director will send completed LIC 9227 for infants and send proof to Licensing.
Type B
Section Cited
CCR
101419.2(a)
Infant Needs and Services Plan
(a) Prior to the infant's first day at the center, the infant care center director or assistant director shall complete a needs and services plan for the infant.

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 4 out of 6 persons which poses a potential health, safety or personal rights risk to persons in care. There were four infants who did not have needs and service on file.
POC Due Date: 04/11/2023
Plan of Correction
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By POC 04/11/2023, director will have parents fill out needs and service and send proof to Licensing.
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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Page: 4 of 5
Document Has Been Signed on 04/05/2023 04:33 AM - It Cannot Be Edited


Created By: Samantha Yip On 04/04/2023 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: CHILDREN'S COURTYARD, THE
FACILITY NUMBER: 434415769

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

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.3(a)
Modifications to Infant Needs and Services Plan
(a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.

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 2 out of 6 persons, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/11/2023
Plan of Correction
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By 04/11/2023, Director will have parent updated needs and service plan and send proof to Licensing.
Type B
Section Cited
CCR
101427(j)
Infant Care Food Service
(j) Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. LPA observed that there were bottles and containers that did not have the infant's name and current date.
POC Due Date: 04/11/2023
Plan of Correction
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Director will send written plan on how the center will ensure that bottles, dishes, and containers of food brought from home is labeled.
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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