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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444413558
Report Date: 07/07/2022
Date Signed: 07/07/2022 02:35:07 PM

Document Has Been Signed on 07/07/2022 02:35 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:GIVING TREE ACADEMYFACILITY NUMBER:
444413558
ADMINISTRATOR:SOSA, JENNIFERFACILITY TYPE:
850
ADDRESS:175 LAWRENCE AVENUETELEPHONE:
(831) 722-7811
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 90TOTAL ENROLLED CHILDREN: 32CENSUS: 27DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Jennifer SosaTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Jenifer Sosa, for an unannounced Required- 1 Year Inspection. LPA was granted access to the facility by the Site Director and toured both indoors and outdoors during the inspection. Upon arrival, there were 17 children in the 2-3 classroom with 2 fully qualified teachers and 10 children in the 4-5 classroom with 1 fully qualified teacher and 2 assistants 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, 7:00AM-5:00PM.

Site Director was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. LPA advised Site Director to submit updated facility roster with all children's names. Sign-in/out was observed to be completed with full legal signature and time of day. The last fire drill was conducted 3/29/2022, which is compliant with the six-month requirement for facilities. LPA observed a fully charged 3A40BC fire extinguisher, functioning smoke detector and carbon monoxide detector. LPA advised Site Director to have fire extinguishers serviced as last service was 10/2020. Site Director states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. The Site Director states that there are no weapons or firearms on the premises.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: GIVING TREE ACADEMY
FACILITY NUMBER: 444413558
VISIT DATE: 07/07/2022
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers, Section 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 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

Indoor areas of the facility (Building A, Rooms 1 & 2) were inspected by the LPA today and observed to be clean, orderly, and safe for the day care children. Site Director states that Building C is currently not in use for day care and is currently being utilized for storage. LPA advised Site Director that repairs to the building will need to be completed as it is currently still a licensed building for children. LPA observed four (4) 3A40BC fire extinguishers in Building C that were last serviced 10/2018.

In Building A, LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. Furniture, such as tables, chairs, and shelves, are in good condition and safe for children. The floors were clean and free of tripping hazards. Drinking water is readily available for children in the facility via water dispensers and water bottles from home. The children’s bathrooms are clean, sanitary, and operable. There is a separate staff bathroom, not utilized by the children, which an isolated child can use if necessary. The Site Director has a working telephone (cell phone) in the facility.

The outdoor area of the facility was inspected and observed to be fenced in. LPA observed play equipment was in good condition and age-appropriate. Playground utilized by children needs more resilient materials (tanbark) to absorb falls as the ground underneath is currently exposed. Site Director states that one playground is not utilized by the children and staff monitor it to prevent childrens use. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by building overhang and large trees outside.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
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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: GIVING TREE ACADEMY
FACILITY NUMBER: 444413558
VISIT DATE: 07/07/2022
NARRATIVE
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Children bring their own lunch and the facility provides midmorning snack and midafternoon snack to children. The menu for snack at this facility repeats weekly and parents are made aware of the schedule upon registration. The kitchen and storage area is clean and free of litter and rubbish. Equipment necessary for the storage, preparation and service of food is well maintained, clean, and sanitized after each use.

10 children’s files were reviewed during today’s inspection and all required documents were present including current immunization charts.

6 staff files (Site Director /3 Teachers/2 Aides) were reviewed and most required documents were present including proof of immunization (tDap, MMR, flu) and required course work. There is at least one staff member present with current CPR/First-Aid that expires 1/2023. The Site Director has current Mandated Reporter Training that expires on 7/22/2023. LPA reminded Site Director that the Mandated Reporter Training must be renewed by all staff every 2 years.

The Site Director understands that she 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 Site Director 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 the Site Director, Jenifer Sosa.

As a result of today’s inspection, deficiencies were 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: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/07/2022 02:35 PM - It Cannot Be Edited


Created By: Cortney Nelson On 07/07/2022 at 01:49 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: GIVING TREE ACADEMY
FACILITY NUMBER: 444413558

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.954
Licensure Requirements
Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above for both room 1 & 2 in Building A, which posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/08/2022
Plan of Correction
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Site Director found carbon monoxide detectors and plugged them in during todays inspection. LPA advised that Building C should also have carbon monoxide detectors as well.
Type B
Section Cited
CCR
101239.1(b)(5)
Napping Equipment
(b) Floor mats used for napping shall be: (5) Maintained in a safe condition with no exposed foam.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above for multiple floor mats used for napping, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/08/2022
Plan of Correction
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Site Director will no longer use nap mats for children that have foam exposed. Facility will remove mats that have foam exposed and submit photo of mats in good repair for the number of children currently enrolled at the facility by 7/8/2022.
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: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022


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Document Has Been Signed on 07/07/2022 02:35 PM - It Cannot Be Edited


Created By: Cortney Nelson On 07/07/2022 at 01:49 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: GIVING TREE ACADEMY
FACILITY NUMBER: 444413558

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above for Building C, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2022
Plan of Correction
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Site Director will submit proof of scheduled work order or photos of repairs by 8/8/2022 for wooden ramp that is degrading outside of the facility and water leak from the ceiling in Room 8. Building is still considered licensed space and should be maintained/repaired prior to children utilizing the space.
Type B
Section Cited
CCR
101238.2(e)
Outdoor Activity Space
(e) As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above for tanbark around the preschool playground, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/22/2022
Plan of Correction
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Site Director will refill the playground area with tanbark, specifically at the base of the slide and under the monkey bars. LPA advised that expsed mesh is cut or covered with enough tanbark to prevent tripping hazard for children. Photos of refilled tanbark should be submitted by 7/22/2022.
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: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 07/07/2022 02:35 PM - It Cannot Be Edited


Created By: Cortney Nelson On 07/07/2022 at 01:49 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: GIVING TREE ACADEMY
FACILITY NUMBER: 444413558

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above for 1 out of 5 staff present, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/14/2022
Plan of Correction
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Site Director will submit Mandated Reporter certificate for staff member, Melissa, by 7/14/2022. (www.mandatedreporterca.com Child Care Provider AB1207) LPA advised that new hires have 90 days from start to complete training.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022


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