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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444415700
Report Date: 07/21/2022
Date Signed: 07/21/2022 03:09:44 PM

Document Has Been Signed on 07/21/2022 03:09 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:BUILDING KIDZ SCOTTS VALLEYFACILITY NUMBER:
444415700
ADMINISTRATOR:MISTRY, ANISHAFACILITY TYPE:
850
ADDRESS:106 VINE HILL SCHOOL ROADTELEPHONE:
(831) 438-4813
CITY:SCOTTS VALLEYSTATE: CAZIP CODE:
95066
CAPACITY: 45TOTAL ENROLLED CHILDREN: 56CENSUS: 42DATE:
07/21/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Marissa Cooney-MooreTIME COMPLETED:
03:21 PM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with Site Director, Marissa Cooney-Moore, for an unannounced Annual/Random Inspection and Capacity Increase. LPA was granted access to the facility by staff member, Bethzaida Ventura, and toured both indoors and outdoors during the inspection. LPA observed all required postings near the entrance to the facility. Hours of operation for the facility are Monday – Friday, 7:30AM-5:00PM.

Upon arrival, there were 42 children present in the following groups:
-11 four year olds with one qualified teacher and one assistant
-11 three year olds with one qualified teacher and one qualified assistant
-10 toddlers with one qualified teacher and one qualified assistant
-10 four year olds "pre-K" with one qualified teacher

LPA reviewed sign-in/out sheets, facility roster (LIC9040), and fire/disaster drill log during today’s inspection. LPA advised Site Director that sign-in/out should be completed with full legal signature and time of day by the legal guardian/parent. The last fire/disaster drill was conducted on 6/28/2022, which is compliant with the six-month requirement for facilities. LPA observed a fully charged 3A40BC fire extinguisher (serviced 1/2022), functioning smoke detector and carbon monoxide detector. There is an additional 1A10BC fire extinguisher (serviced 1/2022) located in the kitchen. Site Director states there are currently children in care who require Incidental Medical Services. Medication is properly stored out of reach of children, in a locked box, with the proper documentation. LPA advised separate container for EpiPens to be stored, inaccessible to children. The Site Director states that there are no weapons or firearms on the premises.

This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual- Regulation Interpretations and Procedures for Child Care Centers, Section 101173 and 101226. 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: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 07/21/2022 03:09 PM - It Cannot Be Edited


Created By: Cortney Nelson On 07/21/2022 at 01:57 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: BUILDING KIDZ SCOTTS VALLEY
FACILITY NUMBER: 444415700

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(1)(B)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for one bottle of Children's Benadryl with parent dosage higher than box recommendation for two children in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2022
Plan of Correction
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Site Director will contact parents of medication and request physicians report to provide children with dosage indicated by parent. LPA advised that Site Director check that all non-prescription medication dosage follows recommendations on the bottle and will require physicans note otherwise.
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 a broken window observed in the kitchen, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/29/2022
Plan of Correction
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Site Director will submit repair order or plan for repairing the window at the facility, outlining the dates in which the window will be replaced. Window is currently taped together and located in the kitchen and above children's outdoor play space.
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: 07/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022


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Document Has Been Signed on 07/21/2022 03:09 PM - It Cannot Be Edited


Created By: Cortney Nelson On 07/21/2022 at 01:57 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: BUILDING KIDZ SCOTTS VALLEY
FACILITY NUMBER: 444415700

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
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
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for 5 children out of 37 present who were not signed in upon arrival, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2022
Plan of Correction
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Site Director will send reminder to authorized representatives that full legal signature is required upon sign-in/out. A copy of completed sign-in/out sheets for 7/22, 7/25, & 7/26 will be submitted to Licensing with full legal signature for all authorized representatives.
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: 07/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022


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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: BUILDING KIDZ SCOTTS VALLEY
FACILITY NUMBER: 444415700
VISIT DATE: 07/21/2022
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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. 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. There is a toddler component at the facility that has a walkway through the building to access separate bathroom. Site Director understands that the preschool and toddler components should not intermingle at any time. The toddler room is equipped with a changing table that was observed to be padded, within arms reach of a sink, and in safe condition. 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 toddler component has an outside area that is physically separated from the preschool outside area. LPA observed play equipment was in good condition, age-appropriate, and has sufficient resilient materials (turf) to absorb falls. No outdoor bodies of water were observed during today’s inspection. Shaded rest area is provided by canopy and building overhang. LPA advised Site Director that sandbox should be maintained and cleaned (raked) as needed before use by children.

LPA discussed the safe sleep regulations with Site Director 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.

Snacks are provided by the facility and are stored and served in a safe and healthful manner to the 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. LPA advised repairing kitchen window that is currently broken and moving various items to be inaccessible to children.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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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: BUILDING KIDZ SCOTTS VALLEY
FACILITY NUMBER: 444415700
VISIT DATE: 07/21/2022
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10 children’s files were reviewed during today’s inspection and all required documents were present including Acknowledgement of Receipt of Licensing Report (LIC9224) from inspection on 6/17/2021. LPA discussed nap check documentation requirement for children under 2 years of age and provided PIN 20-24 CCP for Site Director to review.

8 staff files (site director/ 4 teachers/ 3 aides) were reviewed and all required documents were present. The Site Director has current CPR/First-Aid that expires 6/18/2024 and Mandated Reporter Training that expires on 11/21/2022. LPA reminded Site Director that CPR/First-Aid and Mandated Reporter Training must be renewed every 2 years.

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.

Per the pre-licensing measurements conducted on 4/4/2018, indoor measurements at the facility are as follows:
321.993 + 140.972 + 91.555 + 242.921 + 240.625 = 1973.726
Total Encumbered Space subtracted from total SQ amount: 12 x 12 = 144
1973.726 - 144 = 1829.726 Total SQ divided by 35 = 52 children

Per pre-licensing measurements conducted on 5/22/2018, the designated walkway to be subtracted from the total SQ:
Walkway = 163.503 SQ // Total SQ = 1829.726
1829.726 - 163.503 = 1666.223 Total SQ divided by 35 = 47 children
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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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: BUILDING KIDZ SCOTTS VALLEY
FACILITY NUMBER: 444415700
VISIT DATE: 07/21/2022
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The terms of the original pre-licensing visit will still remain for the walkway through the facility:
- 1:1 ratio for direct supervision for toddler age children to be escorted to the restroom
- Sufficient staffing to allow a staff escort for toddler age children as needed
- Staff designated to escort children shall not be included in classroom ratios to ensure availability as needed
- The walkway shall remain unaltered and shall remain clear during hours of operation
- Preschool operations shall not use the designated walkway for activity space

LPA requested that Site Director submit updated Emergency Disaster Plan (LIC610) with two sites for emergency relocation as well as an updated Facility Sketch (LIC999).

Based on todays inspection, the capacity increase at the facility has been APPROVED for a maximum of 47 children. An updated facility license with increased capacity will be sent to the facility.

Exit interview conducted and report was reviewed with the Site Director, Marissa Cooney-Moore.

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: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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