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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416196
Report Date: 06/22/2021
Date Signed: 06/22/2021 03:50:40 PM

Document Has Been Signed on 06/22/2021 03:50 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:COMMUNITY FIRST SCHOOLFACILITY NUMBER:
434416196
ADMINISTRATOR:LE, DIEU-MIFACILITY TYPE:
850
ADDRESS:1098 WEST REMINGTON DRIVETELEPHONE:
(408) 739-2022
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 144TOTAL ENROLLED CHILDREN: 0CENSUS: 49DATE:
06/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Dieu-Mi Le & Thao TranTIME COMPLETED:
12:10 PM
NARRATIVE
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#2 Licensing Program Analysts (LPAs) Marilou Monico and Elizabeth Larios conducted an unannounced Annual Required inspection. LPAs met with Site Director, Dieu-Mi Le, and Licensee Representative, Thao Tran, and informed them the purpose of today's inspection. Facility's License, Notification of Parents’ Rights Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday 7:00 AM to 06:00 PM. Age serve is two years to entry into kindergarten.

The Preschool Program is operating in Rooms 2, 3, 6, 7, 8 and 9. The preschool children use the playground located in Yard 2b and Yard 3.

LPAs toured the facility both indoor and outdoor. LPAs observed that the facility was operating in compliance with teacher to children ratio requirement. Children were engaged in activities under the supervision of the teachers. The classrooms, restrooms, and storage areas were inspected. There were no bodies of water observed. Licensee Representative stated that facility do not have weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. LPAs observed cleaning solutions in the lower cabinet in Room 3 accessible to children. Site Director removed immediately and placed the items in the upper cabinet inaccessible to children. Restrooms for children to use were observed to be in operating conditions. Floors were clean.

Outdoor activity spaces are enclosed by fencing and are observed to be free of hazards. LPAs observed play equipment were in good condition. LPAs observed areas under the swings and slide were low in woodchips. Drinking water was readily available to children indoor and outdoor. Activities schedule and Menu were posted. Facility provides lunch and snacks (morning and afternoon). Lunch and snacks are prepared at the facility. LPAs observed that food storage areas were clean and free of litter.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: COMMUNITY FIRST SCHOOL
FACILITY NUMBER: 434416196
VISIT DATE: 06/22/2021
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Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on, and were in good repair. Fire extinguisher, smoke and carbon monoxide detectors were observed.

This facility is providing Incidental Medical Services – IMS Plan. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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.

LPAs reviewed sign in and out record, and procedure. A sampling of children and staff files was taken for review during today's inspection. Children records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment and Immunization.

Staff records reviewed include Criminal Record and Child Abuse Index Clearance, Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record and required Training. LPAs reminded Site Director and Licensee Representative that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPAs reminded Site Director and Licensee Representative of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
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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: COMMUNITY FIRST SCHOOL
FACILITY NUMBER: 434416196
VISIT DATE: 06/22/2021
NARRATIVE
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LPAs also reviewed with Site Director and Licensee Representative the violations that would result in an immediate assessment of civil penalty in the amount of $500. Site Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

In the areas that were evaluated, two regulatory violations were observed at the time of the visit; therefore citations were issued. Exit interview was conducted, where this report, the citations, plan of correction, and appeal rights were reviewed with Site Director and Licensee Representative.

A copy of this report was provided to the facility at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED. SITE DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/22/2021 03:50 PM - It Cannot Be Edited


Created By: Marilou Monico On 06/22/2021 at 01:36 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: COMMUNITY FIRST SCHOOL
FACILITY NUMBER: 434416196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/23/2021
Section Cited
CCR
101238.2(e)

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Outdoor Activity Space - As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.
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Woodchips were added under the swings and slides during the inspection.

Deficiency corrected.
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This requirement is not met as evidenced by: LPAs observed that areas under the swings and slide were low in woodchips. This poses a potential risk to the health and safety of children in care.
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Type B
06/23/2021
Section Cited
CCR101238(g)

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Buildings and Grounds - Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.
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Site Director removed the items immediately and placed them in the upper cabinet inaccessible to children during the inspection.

Deficiency corrected.
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This requirement is not met as evidenced by: LPAs observed cleaning solutions in the cabinet in Room 3 accessible to children. This poses a potential risk to the health and safety to children in care.
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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:Anthony Studebaker
LICENSING EVALUATOR NAME:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2021


LIC809 (FAS) - (06/04)
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