434416249-4-28-2023-07-CC-FRAA-CRBSLN-20230428135838

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416249
Report Date: 04/26/2023
Date Signed: 04/28/2023 01:59:12 PM

Document Has Been Signed on 04/28/2023 01:59 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:	PRIMROSE SCHOOL OF EVERGREEN		FACILITY NUMBER:	434416249
ADMINISTRATOR:	GERANNY NATIVIDAD		FACILITY TYPE:	830
ADDRESS:	3008 ABORN ROAD		TELEPHONE:	(408) 440-8215
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	36	CENSUS: 28	DATE:	04/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Geranny Natividad		TIME COMPLETED:	04:20 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 Analysts (LPAs) Farida Raja and Melvin Matos conducted an unannounced Required - 1 Year Inspection in the Infant with Toddler Component Program. LPAs met with Director, Geranny Natividad, Assistant Director, Anna Yin and Owner, Bejal Patel and explained the purpose of the today's visit. The facility is licensed to serve children ages 6 weeks to 36 months in four rooms. Preschool (#434416248), and school age license (#434416250) are on the same premises. LPAs observed the required posted materials including menus and daily activity schedules. Days and hours of operation are Monday through Friday, 6:30am to 6:30pm. LPAs observed: Infant 1 (6 weeks to 12 months): 2 Teachers and 6 Infants. Infant 2 (10 -13 months): 2 Teachers and 7 Infants. Toddler 1 (12-24 months): 2 Teachers and 6 children. Toddler 2 (15-24 months): 2 Teachers and 8 children. Facility was in compliance with teacher to children ratio requirement. LPAs toured the indoor and outdoor areas of the Infant Program during today's inspection. The classrooms, staff restrooms, kitchen and office area were inspected. There is a working telephone in the facility (408-440-8215). Furniture and equipment were age appropriate and free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions or chemicals that are dangerous to the health and safety of children and were inaccessible to the children in care. The facility has central heating/air. LPAs observed solid waste containers with tight-fitting lids in the rooms. There is a separate trash can with tight fitting cover for the disposal of diapers in each room. Director states that there are no weapons or firearms on the premises. Any medications at the Facility are stored in a refrigerator in the front lobby and are inaccessible to children in care. Director stated that crib sheets are washed daily by teachers.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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: PRIMROSE SCHOOL OF EVERGREEN	FACILITY NUMBER: 434416249
	VISIT DATE: 04/26/2023

NARRATIVE

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LPAs observed that all feeding chairs, cribs and equipment is in good condition and safe for children. LPAs observed appropriate changing tables that have raised sides (3 inches in height) and have vinyl changing pads that are at least 1 inch thick. Toilets and faucets are clean and operable.

LPAs observed fire extinguishers, working smoke and carbon monoxide detectors, and fire pull stations. The facility has a built-in smoke detector/ fire system. Log shows that the last Fire Drill was conducted on 04/11/2023 which is compliant with the six-month requirement for facilities. Facility does not provide transportation to children.

Drinking water is readily available for the children in each room and in the outdoor playground area via individual sippy cups/water bottles. Food storage and preparation areas were observed to be sanitary. The kitchen and storage area is clean and free of litter and rubbish. Foods and beverages were stored safely to prevent contamination and spoilage. All food and beverages that require refrigeration are stored in covered containers at 45 F or less. Director stated that the facility does not allow outside food except for infants because of food allergies and dietary restrictions. The facility provides lunch and three snacks throughout the day. The menu is in writing and posted at least one week in advance, accessible to authorized representatives. LPA's advised that snack menu should have portion sizes for food served. Director stated that they use the Procare app to update parents in real time regarding their child's day including diaper changes, meals, snacks and naps.

The outdoor area of the facility was inspected and observed to be fenced in. Playground and play equipment were inspected and observed to be age appropriate and free of hazards. There are adequate equipment, supplies, and toys for children outdoors. The entire outdoor area for infants and toddlers is cushioned with artificial grass to absorb falls and rubber mats are present under swings. Shade is provided by one large canopy in both areas. There were no bodies of water observed.

Children sign in and out procedures and logs were reviewed. Children's Roster was reviewed, and a copy was provided to the LPAs. A sampling of 7 children's files and 11 staff files were reviewed. All children's and staff files were complete with all required documentation. The Facility was in compliance with the Safe Sleep regulations/requirements, including the Infant Sleeping Plan (LIC 9227) and 15 minute checks and logs. Needs and Services Plans were observed in 4 out of 4 infants files.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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: PRIMROSE SCHOOL OF EVERGREEN	FACILITY NUMBER: 434416249
	VISIT DATE: 04/26/2023

NARRATIVE

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All staff files reviewed contain the required immunization records and Health Screening Report. At least one staff member on site has a current CPR and First Aid certification on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). All staff have the required Immunization's against Pertussis, Measles an Influenza (or an Opt out statement). LPAs also observed the required Mandated Reporter Training on file for all staff. LPA's reminded that Pediatric CPR/ First Aid and Mandated Reporter trainings must be renewed every 2 years.

Director stated that facility does not handle medications and currently has no children in care who require Incidental Medical Services (IMS). Isolation of sick child was discussed, and Director explained that sick children will be isolated in the director's office and isolation equipment will be provided. A staff restroom which is off limits to other children is used if necessary. Child is always under visual supervision while in care of the facility. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding Americans with Disabilities Act (ADA) was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) & link to Commonly Asked Questions and the ADA, available at:<http://www.ada.gov/childqanda.htm>
LPAs reminded Director 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 with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person. LPA also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.ccld.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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: PRIMROSE SCHOOL OF EVERGREEN	FACILITY NUMBER: 434416249
	VISIT DATE: 04/26/2023

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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the Director, Geranny Natividad and Owner, Bejal Patel.

As a result of today's inspection, there were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Farida Raja	TELEPHONE: (916) 926-9269
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

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