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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430700960
Report Date: 02/10/2022
Date Signed: 02/10/2022 10:21:09 AM

Document Has Been Signed on 02/10/2022 10:21 AM - 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:ACTION DAY NURSERY ON MOORPARKFACILITY NUMBER:
430700960
ADMINISTRATOR:STRANGE, BRITTANYFACILITY TYPE:
850
ADDRESS:3030 MOORPARK AVENUETELEPHONE:
(408) 247-6972
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 233TOTAL ENROLLED CHILDREN: 233CENSUS: 108DATE:
02/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Brittany StrangeTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Marilou Monico conducted a case management inspection. LPA learned from interviews that on November 22, 2021, a fully qualified teacher and a teacher's aide who completed more than 6 semester or equivalent quarter units in early childhood education were supervising 21 children in the playground.

Deficiency was cited on the next page:

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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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Document Has Been Signed on 02/10/2022 10:21 AM - It Cannot Be Edited


Created By: Marilou Monico On 02/10/2022 at 09:42 AM
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: ACTION DAY NURSERY ON MOORPARK
FACILITY NUMBER: 430700960

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/11/2022
Section Cited
CCR
101216.3(b)(1)

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Teacher-Child Ratio - The licensee may use teacher aides in a teacher-child ratio of one teacher and one aide for every 15 children in attendance. (1) A ratio of one fully qualified teacher (as specified in Section 101216.1(c)) and one aide for every 18 children in attendance in a preschool program is allowed when the aide meets the qualifications specified in Section 101216.2(d).
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Site Director submitted proof that the teacher's aide is currently enrolled in early childhood education (4 quarter units) was submitted to Licensing.

Deficiency corrected.
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This requirement was not met as evidenced by: LPA learned from interviews that on 11/22/21 a fully qualified preschool teacher and a teacher's aide who completed more than 6 semester or equivalent quarter units in early childhood education were supervising 21 children in the playground. This poses a potential risk to the health, safety, and personal rights of children in care.
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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:Marilou Monico
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2022


LIC809 (FAS) - (06/04)
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