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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444417001
Report Date: 04/16/2024
Date Signed: 04/16/2024 03:59:22 PM

Document Has Been Signed on 04/16/2024 03:59 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SPROUTS SCFACILITY NUMBER:
444417001
ADMINISTRATOR/
DIRECTOR:
JORDAN BEMELFACILITY TYPE:
840
ADDRESS:840 NORTH BRANCIFORTE AVENUETELEPHONE:
(831) 429-3898
CITY:SANTA CRUZSTATE: CAZIP CODE:
95062
CAPACITY: 50TOTAL ENROLLED CHILDREN: 65CENSUS: 23DATE:
04/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:16 PM
MET WITH:Jordan BemelTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Jessica Bongardt met with Jordan Bemel, Licensee, for an unannounced Required - 1 Year inspection. LPA toured the indoor and outdoor areas of the Facility with Jordan during today's inspection. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), menus, and Activity Schedule. Days and hours of operation are Monday to Friday 3:00PM-6:00PM and on Wednesday 12:00PM-6:00PM. The facility is licensed to serve a maximum of 50 School Age Children.

LPA reviewed six children's and two staff files during today's inspection. Each child's file reviewed contains all required forms/documents, including Admission Agreement, Emergency Medical Consent (LIC 627), and Information and Emergency Information form (LIC 700). One staff file reviewed contain the required forms/documents, including transcripts/immunization records, and Health Screening Report (LIC 503). Directors file was not complete and needs to be director qualified. All staff have a current Mandated Reporter Certificate on file. Facility has one staff with current CPR and First Aid certification on file. Licensee understands 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. Last fire/disaster drill was completed on 10/25/2023.

LPA observed that the teacher/child ratio was complying during today's inspection. LPA observed 23 children and 2 staff during today's inspection. Jordan understands the conditions, limitations, and capacity specifications of the facility license. Licensee understands that children shall be always visually supervised. If a child comes to the facility who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted into care. Any children who become ill during the day, shall be isolated in the office area or outside on the tables while they wait for a parent/guardian to come and pick them up.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SPROUTS SC
FACILITY NUMBER: 444417001
VISIT DATE: 04/16/2024
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Licensee understands that children's personal rights should not be violated, including no unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature.

LPA observed that the facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. Jordan states that the facility has janitorial service from the school that comes to clean and understands that the facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children. Drinking water is made available to the children by reusable water bottles that are brought from home and water fountains in the classroom and outside. They can be refilled by the water faucets inside and outside the facility. Lead water testing was completed on this facility 01/05/2023.

LPA observed there is cold running water, refrigerator, stove, and microwave on the premises. The facility does provide food for the children, only PM snack. The Facility has trash cans with tight fitting lids for solid waste in the classrooms. Cleaning supplies are inaccessible to the children and stored in cabinets located in areas off limits to children. LPA observed one complete first aid kit available in the facility. The facility has a working pull fire alarm system and carbon monoxide detector. There is one 2-A-10-BC fire extinguisher located in the facility. There are no weapons located at the facility.

The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade rest area is provided by a standing structure with tables underneath to sit. There are sufficient resilient materials on the outdoor playground area. LPA did not observe any bodies of water. Licensee states that the facility does not provide transportation for children.

*Licensee was reminded that all adults 18 and over living or working in the center, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days/$3000.00 per person will be assessed if this regulation is violated.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
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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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SPROUTS SC
FACILITY NUMBER: 444417001
VISIT DATE: 04/16/2024
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*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. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

This facility does not provide Incidental Medical Services – IMS at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 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 (USDOJ) 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

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/inspection-process

One deficiency was cited during today’s visit, exit interview conducted and the report was reviewed with Licensee, Jordan Bemel.

Appeal rights were given

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/16/2024 03:59 PM - It Cannot Be Edited


Created By: Jessica Bongardt On 04/16/2024 at 03:44 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: SPROUTS SC

FACILITY NUMBER: 444417001

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 04/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101515(b)
School-Age Child Care Center Director Qualifications and Duties
(b) All school-age child care centers shall have a director.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/03/2024
Plan of Correction
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Licensee will submit the Directors Packet via email and also send an original copy of the LIC 200A to the department before the plan of correction date.
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:Belinda Devall
LICENSING EVALUATOR NAME:Jessica Bongardt
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


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