434417113-10-5-2023-07-CC-MMOO-CWBR8G-20231005124756

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417113
Report Date: 10/05/2023
Date Signed: 10/05/2023 12:51:00 PM

Document Has Been Signed on 10/05/2023 12:51 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:	LAUREL PLAY GARDENS		FACILITY NUMBER:	434417113
ADMINISTRATOR:	SOUVANNARY THONGMANIVONG		FACILITY TYPE:	830
ADDRESS:	1050 PARK AVENUE		TELEPHONE:	(408) 645-5783
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	10/05/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Aakriti Beri & Rahul Beri		TIME COMPLETED:	10:30 AM

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 Analyst (LPA), Marilou Monico, and Licensing Program Manager (LPM), Gladys Kuizon, conducted an unannounced Prelicensing Inspection. LPA and LPM met with Applicant Representative, Aakriti Beri, and CEO, Rahul Beri. The applicant is applying for an infant license for 8 children, ages 0-2 years. The center will operate Monday through Friday from 7:30 AM to 6:00 PM. LPA and LPM toured and measured the indoor and outdoor areas of the facility during today's inspection. Indoor Activity Space: INFANT ROOM: 20.83 X 14.00 = 291.62 minus 61.79 (encumbered space) = 229.83 INFANT INDOOR PLAY: 16.67 x 16.42 = 273.73 minus 9.32 (encumbered space) = 264.41 *TOTAL INDOOR SPACE = 494.24 sq. ft. divided by 35 = 14 children* The facility has 1 sink (15) and 1 toilet (15) available for the children. The sink used by children has hot and cold running water. The hot water was measured today at 110 degrees Fahrenheit. The staff bathroom is located adjacent to the kitchen. The isolation of sick children will be in the Director's Office and isolation equipment will be provided. Sick children will use the staff bathroom if needed and will be accompanied by a staff member. Staff and children's bathrooms are sanitary and operable. LPA and LPM observed appropriate lighting in the classrooms. The facility has central heating and air conditioning. First aid supplies are located in the Infant Room. Cleaning products are stored in a cabinet under the sink in the off limit kitchen. Applicant Representative stated that there are no weapons or firearms on the premises. LPA and LPM observed a fully charged 3A40BC fire extinguisher, functioning smoke and carbon monoxide detectors. Continued on Page 2

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LAUREL PLAY GARDENS	FACILITY NUMBER: 434417113
	VISIT DATE: 10/05/2023

NARRATIVE

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Medications will be locked in a lock box located in the kitchen.

LPA and LPM observed that all furniture and equipment is in good condition and safe for the children. The facility will serve morning and afternoon snacks to the children. There is an off-limits kitchen for food preparation. The kitchen is clean and equipped with refrigerator, stove, oven, dishwasher, microwave, and storage space for food. Plastic utensils and plates will be utilized by the facility. There are 2 tables, 8 chairs, 8 cubbies, 4 cribs, 4 mats, and 7 hooks for the children. There is adequate equipment, supplies, and materials for the infants. LPA and LPM observed a diaper changing table within arm's reach of a sink. Transportation will not be provided by the facility.

LPA and LPM observed that the outdoor playground area for infants is not ready for inspection. Applicant Representative was advised to be ready for second Prelicensing Inspection by 10/31/23.

There were no bodies of water observed. Applicant Representative was reminded that initial lead testing results shall be received within 180 days from licensure. Following the initial testing, facility must conduct water testing every 5 years after the date of the first test. Applicant Representative stated that lead testing was completed. Applicant Representative was advised to submit lead testing results to Licensing.

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. Applicant will wait until facility opens to determine IMS needs. 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, available at: http://www.ada.gov/childqanda.htm

LPA discussed the safe sleep regulations with applicant 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 Applicant 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: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LAUREL PLAY GARDENS	FACILITY NUMBER: 434417113
	VISIT DATE: 10/05/2023

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Applicant Representative was reminded that all adults 18 and over, responsible for the administration or direct supervision of staff, persons who provide care and supervision to children, and staff who have contact with children, 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 with Facility Representatives the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted. Assembly Bill (AB 633) was discussed with Facility Representatives. Facility Representatives were informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and resource and referral agencies (R&R) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPA and LPM advised Applicant Representative that a license for 8 children in the infant program will be approved upon completing the following items:

1) Install at least four feet partition separating the crib area from the activity area in the infant room.

2) Install a partition/gate separating the activity area from the diaper changing/bathroom area.
3) Install at least four feet partition/gate separating the Infant Indoor Play Room from the lobby/hallway.
4) Proof of purchase of trash cans for the disposable of solid waste and for the disposable of diapers.
5) Submit copy of Infant Needs and Services Plan and updated job descriptions and lines of supervision.
6) Infant playground is fully set up
7) Hot water in the faucet located in the kitchen.
8) Updated Application for Child Care Center License (LIC 200A)
9) List of furniture and play equipment

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

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