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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710229
Report Date: 12/01/2022
Date Signed: 12/01/2022 02:12:31 PM

Document Has Been Signed on 12/01/2022 02:12 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:CALIFORNIA YOUNG WORLDFACILITY NUMBER:
430710229
ADMINISTRATOR:ANGEL TORNOFACILITY TYPE:
830
ADDRESS:1110 FAIRWOOD AVENUETELEPHONE:
(408) 245-7285
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 19DATE:
12/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Angel TornoTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mel Matos met with Angel Torno, director, for an unannounced case management investigation. Purpose of today's investigation: investigate an Unusual Incident that the Facility self reported to the Department.

The Unusual Incident was reported to Angel Torno, director, on September 1, 2022. Angel states a staff from Portable 2 (infants ages 12-24 months) reported several concerns regarding health/safety and hygiene in Portable 2.

Angel states that she investigated the concerns and concluded that staff had failed to follow health and hygiene protocols in Portable 2. Angel states that those included proper washing of hands, proper washing of reusable dishes, and food service (including proper discarding of food).

Angel states that she spoke to all staff from Portable 2 about the concerns regarding health/safety and hygiene in Portable 2. Angel states that training was also given to all staff from Portable 2 regarding health/safety and hygiene on September 12, 2022. Copy of training agenda provided to LPA.

Based on the available evidence and interview conducted, it is concluded that the personal of children were violated when staff in Portable 2 were not properly washing hands of the children, not properly washing reusable dishes, and not following hygiene protocol in reference to food service (including proper discarding of food). A Type B deficiency is thus cited on the attached page (LIC 809-D).

Exit interview conducted and report was reviewed with the Director, Angel Torno. Copy of appeal rights were provided to Director, Angel Torno.

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

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2022
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 12/01/2022 02:12 PM - It Cannot Be Edited


Created By: Melvin S Matos On 12/01/2022 at 01:35 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: CALIFORNIA YOUNG WORLD
FACILITY NUMBER: 430710229

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/01/2022
Section Cited
CCR
101223(a)(2)

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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Angel Torno, Director, provided training to all staff from Portable 2 regarding health/safety and hygiene on September 12, 2022. Copy of training agenda provided to LPA.
Deficiency is thus cleared.
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This requirement was not met as evidenced by: staff in Portable 2 were not properly washing hands of the children, not properly washing reusable dishes, and not following hygiene protocol in reference to food service (including proper discarding of food). This presents a potential risk to the health/safety 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:Diana Stephenson
LICENSING EVALUATOR NAME:Melvin S Matos
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022


LIC809 (FAS) - (06/04)
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