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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
444416435
Report Date:
07/25/2022
Date Signed:
07/25/2022 05:43:19 PM
Document Has Been Signed on
07/25/2022 05:43 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:
L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER:
444416435
ADMINISTRATOR:
NOLAN, KAREN
FACILITY TYPE:
850
ADDRESS:
3205 SALISBURY DRIVE
TELEPHONE:
(415) 361-1879
CITY:
SANTA CRUZ
STATE:
CA
ZIP CODE:
95065
CAPACITY:
38
TOTAL ENROLLED CHILDREN:
30
CENSUS:
18
DATE:
07/25/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
08:51 AM
MET WITH:
Lanie Choi
TIME COMPLETED:
06:00 PM
NARRATIVE
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Li
censing Program Analyst (LPA), Cortney Nelson, met with
Site Director, Lanie Choi
, for an unannounced Required- 1 Year Inspection. LPA was granted access to the facility by the
Staff Member, Andrea Rocha,
and toured both indoors and outdoors during the inspection. Upon arrival, there were
18 preschool-age
children
and
5 staff (4 teachers/1 assistant)
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, 7:30AM-5:30PM
.
LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. The facility uses digital sign-in/out via app "1Core" and LPA observed sign-in utilizes a code, not parent/guardian full legal signature. The last fire/disaster drill was conducted on
4/4/2022,
which is compliant with the six-month requirement for facilities. LPA observed two fully charged
2A10BC
fire extinguishers (last serviced: 1/2021), functioning smoke detector and carbon monoxide detector.
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.
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
SUPERVISORS NAME
:
Joel Segura
LICENSING EVALUATOR NAME
:
Cortney Nelson
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/25/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2022
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:
L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER:
444416435
VISIT DATE:
07/25/2022
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. The facility has two classrooms currently utilized for the preschool license, Room #1 & Room #2. Room #1 has kitchen space and bathroom located within the classroom that is also utilized by Room #2. LPA observed sufficient age-appropriate materials, toys, and play equipment in the facility. 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 labeled with the children’s names.
Staff and 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 in the facility.
The outdoor area of the facility was inspected and observed to be fenced in. The facility currently has an active waiver for playground use with the conditions that no more than 32 children should use the playground at one time and schedule for the playground should be posted in every room. LPA observed all requirements for playground waiver were met during today's inspecition. LPA observed play equipment was in good condition and age-appropriate. LPA advised that more resilient materials
(tanbark)
is needed to absorb falls around the playground swings and base of the slide where ground is exposed. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by
building overhang.
Food is provided by the facility and is stored, prepared, and served in a safe and healthful manner to the children. Facility offers
a full day program and provides
AM snack, PM snack, and lunch
to children. Menu is in writing and posted at least one week in advance, accessible to authorized representatives. The kitchen and storage area is clean and free of litter and rubbish.
10 preschool-age
children’s files
were reviewed during today’s inspection
and most required documents were present. 6 staff files (site director, 4 teachers, 1 teacher aide) were reviewed and most required documents were present. There is at least one staff member present with current CPR/First-Aid that expires 6/26/2023. The Site Director has current Mandated Reporter Training that expires on 4/26/2023. LPA reminded Site Director that the Mandated Reporter Training must be renewed by all staff every 2 years.
SUPERVISORS NAME
:
Joel Segura
LICENSING EVALUATOR NAME
:
Cortney Nelson
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2022
LIC809
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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:
L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER:
444416435
VISIT DATE:
07/25/2022
NARRATIVE
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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.
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, Lanie Choi.
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
.
L
PA
informed Site Director
that this report dated
(7/25/2022)
documents
one (1) Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.
Also, LPA informed the licensee to provide a copy of this licensing report dated
(7/25/2022)
that d
ocuments any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME
:
Joel Segura
LICENSING EVALUATOR NAME
:
Cortney Nelson
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2022
LIC809
(FAS) - (06/04)
Page:
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Document Has Been Signed on
07/25/2022 05:43 PM
- It Cannot Be Edited
Created By:
Cortney Nelson
On
07/25/2022
at
01:53 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:
L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER:
444416435
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/25/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
101170(e)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for 1 out of 7 staff members present, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date:
07/26/2022
Plan of Correction
1
2
3
4
Site Director will immediately have staff member, Eunice Reyes, fingerprinted and submit Livescan form to Licensing by 7/26/2022. Staff should not be present at the facility until fingerprint clearances are completed.
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:
07/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2022
LIC809
(FAS) - (06/04)
Page:
4
of
11
Document Has Been Signed on
07/25/2022 05:43 PM
- It Cannot Be Edited
Created By:
Cortney Nelson
On
07/25/2022
at
01:53 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:
L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER:
444416435
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/25/2022
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
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above for one classroom at the facility which did not have a carbon monoxide detector, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/29/2022
Plan of Correction
1
2
3
4
Site Director will purchase and install a carbon monoxide detector for Classroom #2 and submit photograph/video of it functioning by 7/29/2022.
Type B
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above as cleaning solution spray bottles were observed in the classroom on the counter, accessible to children, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/27/2022
Plan of Correction
1
2
3
4
Site Director will relocate cleaning supplies in each of the rooms to areas which are inaccesible to children and submit photos of relocation site by 7/27/2022. Site Director will give reminder to her staff about proper storage for cleaning supplies.
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:
07/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2022
LIC809
(FAS) - (06/04)
Page:
5
of
11
Document Has Been Signed on
07/25/2022 05:43 PM
- It Cannot Be Edited
Created By:
Cortney Nelson
On
07/25/2022
at
01:53 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:
L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER:
444416435
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/25/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above for area under the swings and at the base of the slide where the ground is visible, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/29/2022
Plan of Correction
1
2
3
4
Site Director will rake tanbark to be redistributed under the swings and base of slide, and if needed, order additional tan bark until ground is no longer visible. LPA advises staff rake tanbark at start/end of day to maintain the playground.Photos of redistributed tanbark should be submitted by 7/29/2022.
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
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for 2 out of 7 staff members, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/05/2022
Plan of Correction
1
2
3
4
Staff who are missing immunizations will set-up appointment to obtain immunization or obtain proof from physician of prior immunization. Proof of immunization should be submitted to Licensing for both staff members by 8/5/2022. (Erika Ramirez- MMR/tDap, Debra Costanzo-MMR)
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:
07/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2022
LIC809
(FAS) - (06/04)
Page:
6
of
11
Document Has Been Signed on
07/25/2022 05:43 PM
- It Cannot Be Edited
Created By:
Cortney Nelson
On
07/25/2022
at
01:53 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:
L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER:
444416435
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/25/2022
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
1
2
3
4
Based on observation, interview and record review, the licensee did not comply with the section cited above for 2 out of 7 staff members, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/29/2022
Plan of Correction
1
2
3
4
Site Director will submit proof of completion for Child Care Providers AB1207 Mandated Reporter training for staff members, Debra Costanzo and Eunice Rameno by 7/29/2022. New hire, Daisy Rojas has 90 days from day of hire to complete Mandated Reporter training.
Type B
Section Cited
CCR
101170(d)
Criminal Record Clearance
(d) All individuals subject to criminal record review shall, be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for 1 out of 7 staff members, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/29/2022
Plan of Correction
1
2
3
4
Site Director will have all staff complete Criminal Record Statement (LIC508) for Child Care facilities and update file in folder. Additionally, staff member Debra Costanzo, needs a Criminal Record Statement as it is not in file. All updates to be submitted to Licensing by 7/29/2022.
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:
07/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2022
LIC809
(FAS) - (06/04)
Page:
7
of
11
Document Has Been Signed on
07/25/2022 05:43 PM
- It Cannot Be Edited
Created By:
Cortney Nelson
On
07/25/2022
at
01:53 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:
L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER:
444416435
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/25/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for 1 out of 7 staff members, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/05/2022
Plan of Correction
1
2
3
4
Site Director will submit physicians report for staff member, Debra Costanzo,by 8/5/2022.
Type B
Section Cited
CCR
101217(a)(12)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Tuberculosis test documents as specified in Section 101216(g).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for 2 out of 7 staff members present, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
08/05/2022
Plan of Correction
1
2
3
4
Site Director will submit proof of negative tuberculosis test for staff members, Debra Costanzo and Eunice Rameno by 8/5/2022.
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:
07/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2022
LIC809
(FAS) - (06/04)
Page:
8
of
11
Document Has Been Signed on
07/25/2022 05:43 PM
- It Cannot Be Edited
Created By:
Cortney Nelson
On
07/25/2022
at
01:53 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:
L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER:
444416435
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/25/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)
Child's Records
(b) Each record shall contain information including, but not limited to, the following:
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for Preadmission Health History- Parents Report for 6 out of 10 childrens files, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/29/2022
Plan of Correction
1
2
3
4
Site Director will submit Health History- Parents Report for all 6 children missing document by 7/29/2022 and retain in childrens file following submission.
Type B
Section Cited
CCR
101229.1(a)(1)
Sign In and Sign Out
(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above for new digital sign-in/out process that does not require full legal signature of parent/guardian, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/29/2022
Plan of Correction
1
2
3
4
Site Director will reach out to application "1Core" and add the function for parents to sign-in/out using full legal signature. Until application is able to intake full legal signature of parents, Site Director will use paper sign-in/out along side digital sign-in until app is compatable with the regulation requirements.
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:
07/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2022
LIC809
(FAS) - (06/04)
Page:
9
of
11
Document Has Been Signed on
07/25/2022 05:43 PM
- It Cannot Be Edited
Created By:
Cortney Nelson
On
07/25/2022
at
01:53 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:
L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER:
444416435
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/25/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101212(b)
Reporting Requirements
(b) The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for new Site Director, Lanie Choi, who started employment 7/1/2022 without reporting to Licensing, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/29/2022
Plan of Correction
1
2
3
4
Site Director will submit qualifications to be reviewed and Owner, Helena Geng, will submit all required supplemental documentation for designation of new site director by 7/29/2022.
Type B
Section Cited
CCR
101170(e)(2)
101170 Criminal Record Clearances (e) All individuals subject to a criminal record review... shall prior to working, residing, or volunteering in a licensed facility (2) Request a transfer of a criminal record clearance
This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, interview, and record review, the licensee did not comply with the section cited above for 3 out of 7 staff members, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/26/2022
Plan of Correction
1
2
3
4
Site Director will transfer fingerprint clearances for staff members who are not currently associated to the facility. (Debra Costanzo, Erika Ramirez, Lanie Choi)
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:
07/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2022
LIC809
(FAS) - (06/04)
Page:
10
of
11
Document Has Been Signed on
07/25/2022 05:43 PM
- It Cannot Be Edited
Created By:
Cortney Nelson
On
07/25/2022
at
04:31 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:
L'ACADEMY PRESCHOOL SANTA CRUZ
FACILITY NUMBER:
444416435
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
07/25/2022
DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
101238 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
1
2
3
4
Based on observation and interview, the licensee did not comply with the section cited above in for dirty diaper changing table located in classroom #1, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date:
07/27/2022
Plan of Correction
1
2
3
4
Site Director will clean the diaper changing table located in Classroom #1, including the table itself and mat that children are changed on. Pictures to be submitted of cleaned changing table by 7/27/2022.
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:
07/25/2022
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/25/2022
LIC809
(FAS) - (06/04)
Page:
11
of
11