444412727-8-18-2021-07-CC-KGOL-C5ZU3Y-20210818151418

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 444412727
Report Date: 08/18/2021
Date Signed: 08/18/2021 03:14:27 PM

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:	CAMPUS KIDS CONNECTION OPAL CLIFFS CHILDREN'S CTR.		FACILITY NUMBER:	444412727
ADMINISTRATOR:	LOPEZ, PATRICIA		FACILITY TYPE:	850
ADDRESS:	4510 JADE STREET		TELEPHONE:	(831) 475-5188
CITY:	CAPITOLA	STATE: CA	ZIP CODE:	95010
CAPACITY:	60	CENSUS: 24	DATE:	08/18/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Patricia Lopez		TIME COMPLETED:	03:45 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), Goodell met with Director Patricia Lopez for an unannounced Annual Inspection. The facility’s hours of operation are Monday- Friday, 7:30AM- 5:30PM. LPA arrived during naptime and observed seven children napping with one staff member present in room 1, 11 children napping with two staff present in room 2 and six children in the outdoor play area with one staff member present. Later during the inspection Executive Director Noel Schermann joined. All individuals present have obtained fingerprint clearance through Community Care Licensing. LPA observed required postings: Facility License (LIC 203A), Personal Rights (LIC9040), Emergency Disaster Plan (LIC610), Earthquake Preparedness Checklist (LIC9148), and Parent’s Rights Poster (PUB393). LPA toured two classroom areas, children’s furniture, play equipment, napping equipment, food service area, and restrooms. Facility provides morning/afternoon snack and lunch. LPA observed current menu and activity schedule posted. LPA observed outdoor area and play equipment. LPA observed drinking water is readily available to children both indoor and outdoor. LPA observed cleaning supplies and medication boxes stored inaccessible to children. LPA observed water is accessible to children both indoor and outdoor. LPA observed fire extinguisher 3A40BC, smoke and carbon monoxide detectors. LPA observe fire drill log and children roster maintained. Report continues on LIC 809-C

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021

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: CAMPUS KIDS CONNECTION OPAL CLIFFS CHILDREN'S CTR.	FACILITY NUMBER: 444412727
	VISIT DATE: 08/18/2021

NARRATIVE

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LPA reviewed children files. Documents included Identification and Emergency Information (LIC700), Child’s Preadmission Health History (LIC702), Child’s Preadmission Health Evaluation (LIC701), Consent for Medical Treatment (LIC627), Notification of Parent’s Rights (LIC 995), Personal Rights (LIC613A).

LPA reviewed staff files and educational requirements. Documents included Health Screening Report (LIC503), TB Clearance, Personal Record (LIC501), Criminal Record Statement (LIC508), Notice of Employee Rights, Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC9108) and certificate for Mandated Reporter Training. LPA observed that at least one staff member present during today’s inspection has current Pediatric CPR/First Aid that expires on 7/2022.

The Effects of Lead Exposure brochure was issued and discussed. Assembly Bill 2370, which will require licensed Child Care Facilities to test their water for excessive amounts of lead. Testing will be required from January 1st, 2020 to January 1st, 2023 and must be conducted every five years from the initial testing.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the director can obtain updated licensing information, new regulations, self-assessment guides and access forms. LPA advised staff of their responsibility to stay current in regards to new regulations.

No Title 22 Deficiency has been cited. Report reviewed and discussed with director. Notice of Site Visit issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021

LIC809 (FAS) - (06/04)

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