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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444414395
Report Date: 06/07/2024
Date Signed: 06/07/2024 04:33:00 PM

Document Has Been Signed on 06/07/2024 04:33 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:
444414395
ADMINISTRATOR/
DIRECTOR:		ELIZABETH ASADIFACILITY TYPE:
830
ADDRESS:175 LAWRENCE AVENUE, BLDG.BTELEPHONE:
(831) 254-0983
CITY:WATSONVILLESTATE: CAZIP CODE:
95076
CAPACITY: 24TOTAL ENROLLED CHILDREN: 6CENSUS: 2DATE:
06/07/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:21 AM
MET WITH:Jenifer SosaTIME VISIT/
INSPECTION COMPLETED:
04:42 PM
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Licensing Program Analysts (LPAs), Cortney Nelson and Jennifer 'Jen' Beehler, met with Site Director, Jenifer Sosa, for an unannounced Annual/Random Inspection. LPAs were granted access to the facility by the Site Director and toured both indoors and outdoors during the inspection. Upon arrival, there were two (2) infants and three (3) staff members present, which is compliant with the facility license capacity and ratio requirements. LPA observed all required postings near the entrance to the facility and the hours of operation are Monday – Friday, 7:00AM-5:00PM.

LPAs 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 with full legal signature and time of day. The last fire drill was conducted on 1/26/2024, which is compliant with the six-month requirement for facilities. LPAs observed three fully charged 3A40BC fire extinguishers (last serviced: 7/2023), functioning carbon monoxide detector, and a built in fire detection system. LPAs advised annual servicing of fire extinguishers in the facility. Jenifer states that she does not currently have any children in care who require Incidental Medical Services and does not administer medication at this time. There are no weapons or firearms on the premises. LPAs additionally reminded the Site Director that the annual fee for the facility is overdue.

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/.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2024
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GIVING TREE ACADEMY
FACILITY NUMBER: 444414395
VISIT DATE: 06/07/2024
NARRATIVE
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Indoor areas of the facility were inspected by the LPAs today and observed to be clean, orderly, and safe for day care infants. The infant room at the facility is physically separate from the preschool component. LPAs observed sufficient age-appropriate materials, toys, and play equipment in the facility. Toys are safe and do not have sharp edges or small parts that may pose a choking hazard. Infant changing table was observed to be padded, within arms reach of a sink, in good repair and safe condition. Cribs used by the infants are free from loose articles, covered with a fitted sheet, and there are no objects hanging above or attached to the crib. No children in care current use cribs for napping and a mobile was observed attached to one crib, it was removed during today's inspection. The floors are clean and free of tripping hazards and waste containers have tight fitting lids.

All infants have current Needs and Services plan that has been updated quarterly. 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 the 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.

The outdoor area of the facility was inspected and observed to be fenced in. It is physically separated from space utilized by the preschool component. LPAs observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (tanbark) to absorb falls. There is a properly maintained sandbox outside for infants use and plastic play structures. LPAs advised that plastic play structures are securely placed on the tanbark as infants may rely on those structures for standing purposes. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by large canopy.

Five (5) infant files were reviewed during today's inspection and all required documents were present. Infant nap logs are completed every 15 minutes and include time of check and initials of the staff member checking on the infant.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024
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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: 444414395
VISIT DATE: 06/07/2024
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Four (4) staff files were reviewed and most required documents were present. LPAs reminded to renew Mandated Reporter training every two years and document immunization to measles, pertussis, and flu/declination. The Site Director has current First-Aid/CPR that expires 7/2025.

Licensee 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.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. The facility has not completed water lead testing and has advised that children in care are offered disposable water bottles when drinking water is given. LPAs advised that any faucets used for food preparation shall also be tested for water lead contamination. If the facility does not use any faucets for drinking water or food preparation, a written attestation shall be submitted to the Department along with a facility sketch indicating all water faucets in the facility.

Exit interview conducted and report was reviewed with the Site Director, Jenifer Sosa.

As a result of today’s inspection, deficiencies were cited, see LIC809-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 may 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 CARE tools, please send email inquiries 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/inspection-process.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/07/2024 04:33 PM - It Cannot Be Edited


Created By: Cortney Nelson On 06/07/2024 at 03:53 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: 444414395

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

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 as water lead testing has not been completed for the facility, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2024
Plan of Correction
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The facility shall submit date for water lead testing if any faucets are used for food preparation or drinking water. If none are used for those purposes, the facility shall submit written attestation and facility sketch that indicates all faucets in the facility. Test date or attestation shall be submitted by 6/28/2024.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above as three staff members were missing proof of immunizations in the file, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2024
Plan of Correction
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Most POC cleared during inspection, the Site Director shall submit proof of influenza vaccination for one staff member.
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: 06/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2024


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