440710237-12-15-2022-07-CC-CNEN-CM5VXZ-20221215155021

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 440710237
Report Date: 12/15/2022
Date Signed: 12/15/2022 03:50:31 PM

Document Has Been Signed on 12/15/2022 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:	DE LA VEAGA CKC INC.		FACILITY NUMBER:	440710237
ADMINISTRATOR:	PAYA VANG		FACILITY TYPE:	840
ADDRESS:	1145 MORRISSEY BOULEVARD		TELEPHONE:	(831) 426-7402
CITY:	SANTA CRUZ	STATE: CA	ZIP CODE:	95065
CAPACITY: 200	TOTAL ENROLLED CHILDREN: 200	CENSUS:	DATE:	12/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:17 PM
MET WITH:	Jahmar Milette & Noel Shermann		TIME COMPLETED:	04:00 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 Analyst (LPA), Cortney Nelson, met with Site Director, Jahmar Milette, and Executive Director, Noel Shermann, for an unannounced Required- 1 Year Inspection. The facility is located at DeLaveaga Elementary School in rooms 33, 34, and 35. LPA was granted access to the facility by staff present in room 34 and toured both indoors and outdoors during the inspection. Upon arrival, there were ninety three (93) school-age children and twelve (12) staff present, which is compliant with the facility license capacity and ratio requirements. LPA observed all required postings near the entrance to the facility. Hours of operation for the facility are Monday – Friday, after-school-6:00PM (Mon, Tues, Thurs, Fri) and 12:00pm-6:00pm (Wed). LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. Sign-in/out was observed to be completed using Brightwheel with full legal signature and time of day. The last fire/disaster drill was conducted on 11/15/2022 for all rooms, which is compliant with the six-month requirement for facilities. LPA observed two fully charged 3A40BC fire extinguishers, one fully charged 2A10BC fire extinguisher, and functioning carbon monoxide detectors in all rooms. The Site Director states that he currently has children in care who require Incidental Medical Services and LPA observed that the medication is properly stored out of reach of children with the proper documentation (IMS). The Licensee states that there are no weapons or firearms on the premises. This facility provides Incidental Medical Services- IMS. LPA 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, Section 101173 and 101226. The following information regarding ADA was provided: US Department of Justice 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

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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: DE LA VEAGA CKC INC.	FACILITY NUMBER: 440710237
	VISIT DATE: 12/15/2022

NARRATIVE

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Indoor areas of the facility were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Room 33 is primarily used for TK/K, Room 34 is primarily for 3rd, 4th, & 5th grade, and Room 35 is primarily used for 1st, 2nd, and 3rd graders. Noel states that the rooms are not exclusive to those age ranges and they will utilize space as needed to maintain ratio/room capacity. LPA observed sufficient age-appropriate materials, toys, and play equipment in each room. Drinking water is readily available for children in the facility via drinking fountains and water jugs. Children in care use the DeLaveaga Elementary School bathrooms and LPA observed that they are clean, sanitary, and operable. There is a working telephone in the facility.

During today's inspection LPA additionally followed-up on water lead testing conducted for the facility and all classrooms. An Action Level Exceedance of 8.9 was measured for faucet C in room 35. LPA observed that the faucet is currently covered and Noel states that they are working on a solution for the drinking fountain in collaboration with the school district. LPA advised that a more permanent solution is made for the fountain if they do not plan to use it for drinking as the water is unable to be shut off without making the sink next to it also inaccessible.

The facility is located on a school campus and utilizes the school playgrounds for outside play. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (rubber padding) to absorb falls. Noel states that the children use both playgrounds. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by building overhang and large trees.

PM snack is provided by the facility and is stored, prepared, and served in a safe and healthful manner to the children. The snack menu is in writing and posted at least one week in advance, accessible to authorized representatives. Snack is prepared in room 34 and the kitchen and storage area is clean and free of litter and rubbish.

Five (5) school-age children’s files and five (5) staff files were reviewed during today’s inspection and all required documents were present. The Site Director has current CPR/First-Aid and Mandated Reporter Training. LPA reminded Noel that both must be renewed every 2 years.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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: DE LA VEAGA CKC INC.	FACILITY NUMBER: 440710237
	VISIT DATE: 12/15/2022

NARRATIVE

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The Licensee understands that the site director shall be on the premises during the hours the center is in operation and that children at the center shall be visually supervised at all times. LPA reminded the Licensee 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.

Exit interview conducted and report was reviewed with Executive Director, Noel Shermann, and Site Director, Jahmar Milette.

As a result of today’s inspection, a deficiency was cited, see 809-D.

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

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.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/15/2022 03:50 PM - It Cannot Be Edited

Created By: Cortney Nelson On 12/15/2022 at 03:30 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: DE LA VEAGA CKC INC.	FACILITY NUMBER: 440710237
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/15/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

101700.3(b)(1)

101700.3 Lead Testing Written Directives (b)(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance (ALE). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	After water testing was completed at the facility, Faucet C had an ALE of 8.9, which posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/31/2023
	Plan of Correction
1 2 3 4	The Executive Director will work with the school district to find a more permanent solution for the drinking fountain with ALE and submit proof of correction or plan for the correction by 1/31/2023. It is advised that the drinking fountain is removed or water shut off if it will not be flushed or replaced.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Cortney Nelson

LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC809 (FAS) - (06/04)

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