430710174-4-6-2023-07-CC-MMOO-CQMVHQ-20230406162732

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710174
Report Date: 04/06/2023
Date Signed: 04/06/2023 04:31:07 PM

Document Has Been Signed on 04/06/2023 04:31 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:	DE ANZA COLLEGE CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	430710174
ADMINISTRATOR:	NAOKO NANCY HARADA		FACILITY TYPE:	850
ADDRESS:	21250 STEVENS CREEK BLVD.		TELEPHONE:	(408) 864-5795
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY: 217	TOTAL ENROLLED CHILDREN: 75	CENSUS: 61	DATE:	04/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Maritza Fuentes		TIME COMPLETED:	04:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Marilou Monico conducted an unannounced Required - 1 Year Inspection. LPA met with Administrative Assistant, Martiza Fuentes, and explained the purpose of today's visit. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 08:30 AM to 5:00 PM. The Preschool Program is licensed in Rooms 13, 15, 16, 26, 27, 31 and 35. The Toddler Option Program is licensed in Rooms 12 and 14. The facility serves children ages 18 months old to entry into 1st grade. LPA toured the indoor and outdoor areas. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. Cleaning products, disinfectants, sharp objects were stored in the upper shelves inaccessible to children. Furniture and equipment were observed to be age appropriate and in good condition. The facility is clean and orderly. The staff and children's bathrooms are clean, sanitary, and operable. Maritza indicated that the facility has custodian that comes after daycare hours to clean the facility. Snacks and lunch are catered to the center from an outside vendor "Chefables." Drinking water is available for the children indoor via pitchers and disposable cups. LPA observed trash cans with tight fitting covers for the disposal of solid waste and diapers. LPA observed fire extinguishers, working smoke and carbon monoxide detectors. Maritza stated that there are no firearms in the facility. Drinking water is readily available for the children outdoor via pitchers, disposable cups and individual water bottles. The playgrounds are surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by canopies, trees, and building overhang. LPA observed tanbarks and rubber foam as resilient material under and around the climbing structures and swing. There were no bodies of water observed. *Continuation on Pages 2 & 3:*

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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: DE ANZA COLLEGE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 430710174
	VISIT DATE: 04/06/2023

NARRATIVE

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LPA reviewed 10 children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Parent Right's Receipt, Personal Rights, Physician's Report, Health History, Immunization, and TB test.

LPA reviewed 12 staff files. Staff records reviewed include Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Influenza) and required training. LPA reminded Administrative Assistant that the Mandated Reported Training shall be renewed by all staff every two years. At least one staff member present during the inspection has current Pediatric CPR/First Aid certifications.

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 Sections 101173 and 101226. 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

LPA discussed the safe sleep regulations with Maritza and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA informed Maritza 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.

Fingerprint clearances for individuals at this facility who require caregiver background checks are issued by the State Department of Education and/or the County Office of Education.

Continuation on Page 3

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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: DE ANZA COLLEGE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 430710174
	VISIT DATE: 04/06/2023

NARRATIVE

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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.

The following must be sent to Licensing by 04/13/22:
1) Updated Personnel Report (LIC 500)

As a result of this inspection, deficiency was cited on the following page:

Exit interview conducted and report was reviewed with Administrative Assistant, Maritza Fuentes.

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: 04/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/06/2023 04:31 PM - It Cannot Be Edited

Created By: Marilou Monico On 04/06/2023 at 03:51 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: DE ANZA COLLEGE CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 430710174
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/06/2023

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 records review, the licensee did not comply with the section cited above in 6 out of 12 staff, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/20/2023
	Plan of Correction
1 2 3 4	Maritza will submit current Mandated Reporter Training certificate for Staff #2, #3, #4, #8, #11 and #12 by 04/20/23.

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:

Marilou Monico

LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC809 (FAS) - (06/04)

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