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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416394
Report Date: 04/25/2024
Date Signed: 04/25/2024 01:22:13 PM

Document Has Been Signed on 04/25/2024 01:22 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LOS ARROYOS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434416394
ADMINISTRATOR/
DIRECTOR:		OKSANA OKSFACILITY TYPE:
830
ADDRESS:885 MORO DRIVETELEPHONE:
(408) 763-7827
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
04/25/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Director, Oksana OksTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 4/25/2024, at 9:30 AM, Licensing Program Analyst (LPA), Doni Fici, met with Oksana Oks, for an unannounced Required- 1 Year Inspection. LPA was granted access to the facility by director, and toured both indoors and outdoors during the inspection. Upon arrival, there were 0 infants. Director advised LPA that the infants class is closed due to water leakage and will re-open on 5/6/2024. LPA advised director to inform CCL if the re-opening date for infants class changes. LPA observed all required postings near the entrance to the facility and the hours of operation are Monday – Friday, 7:00AM-6:00PM.

The director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA reviewed digital sign-in/out sheets on kindercare, the facility roster (LIC9040), and the fire/disaster drill log during today’s inspection. The last fire/disaster drill was conducted on 4/5/2024, which is compliant with the six month requirement for facilities. LPA observed a fully charged 2A10BC fire extinguisher (last serviced: 1/8/2024), functioning smoke detector and carbon monoxide detector. Director stated that she does not currently have Incidental Medical Services on file and does not administer medication at this time. There are no weapons or firearms on the premises.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LOS ARROYOS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434416394
VISIT DATE: 04/25/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/. No current child with an IMS plan.

Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for day care infants. The infant and toddler room are physically separate from other childcare center components at the facility. LPA observed sufficient age-appropriate materials, toys, and play equipment for infants. Toys are safe and do not have sharp edges or small parts that may pose a choking hazard. The infant changing table was observed to be padded, within arms reach of a sink, in good repair and safe condition. Cots are used by the toddlers, and cribs are used by infants, which are free from loose articles, covered with a fitted sheet, and there are no objects hanging above or attached to them. The floors are clean and free of tripping hazards and waste containers have tight fitting lids.



LPA reminded director that infant Needs and Services plan shall be updated at least quarterly and shall be completed with the infants authorized representative and a representative from the facility, such as a director or lead teacher. The feeding plan is current for all infants and licensee understands that all formula and bottles provided should be labeled individually with the child’s name and date.

LPA discussed the safe sleep regulations with licensee 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 licensee 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.

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SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LOS ARROYOS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434416394
VISIT DATE: 04/25/2024
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The outdoor area of the facility was inspected and observed to be physically separated from space utilized by other child care center components. LPA observed that the fencing that is at least four feet tall. Due to infant room construction, LPA observed outdoor area for infants is not clean and good condition for infants to play. No outdoor bodies of water were observed during today’s inspection. LPA reminded director that shaded rest area is required for outdoor space.

Five (5) children’s files were reviewed and most required documents were present. two (2) staff files was reviewed and LPA advised that infant staff shall have three (3) units related to the care of infants. There is at least one staff member with current First-Aid/CPR and all staff should have a mandated Reporter certificate on file in the center. LPA reminded that both shall be updated every two years.



Licensee understands she shall be on the premises during the hours the center is in operation and that infants at the center shall be visually supervised at all times. LPA reminded 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, such as field trips.

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.

No deficiencies cited during visit today.


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


Exit interview conducted with director and report was reviewed and provided.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
LIC809 (FAS) - (06/04)
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